Three essays on the effect of telemental health and associated policies on adoption and resultant utilization of mental health services in the United States

With the growing burden of mental health disorders and persistent gaps in care, telehealth could be a potential solution to bridge disparities and ensure timely, equitable access to mental health services, particularly for underserved populations. However, its adoption remains uneven due to technological barriers, policies and regulatory hurdles, and patient and provider hesitancy. This dissertation examines the role of telemental health services and policies in influencing mental health care access and utilization through three distinct studies. The first study estimated the effect of providing telemental health services (TMHS) on mental health visit rates in Federally Qualified Health Centers (FQHCs). Findings indicated that TMHS availability significantly increased mental health visits, particularly for depression and anxiety, with greater effects in FQHCs serving more low-income and Medicaid-insured populations. The second study evaluated the effect of Medicaid Audio-Only Coverage (MAOC) on mental health service utilization in FQHCs. The findings suggested that MAOC primarily functioned as a substitute rather than a complementary service to video-based or in-person visits. However, it significantly increased visits in FQHCs without an established telemental health service, indicating its role in improving access to care in settings where video-based telehealth was not feasible. The third study examined how state-level telehealth policies influence hospital-based telepsychiatry adoption. Removing Medicaid geographic and facility-originating site restrictions significantly increased hospital telepsychiatry adoption. Specifically, hospitals serving more psychiatric patients, and those from rural regions benefited from private parity, Medicaid audio-only coverage, and no geographic restriction for mental health services. Together, these studies provided a comprehensive evaluation of telehealth’s role in mental health care, offering insights into policy effectiveness and barriers to adoption.