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

Mental health disorders are a growing public health concern, yet many individuals, particularly those in rural and underserved communities, face persistent barriers to accessing timely and effective care. Telehealth has emerged as a possible solution to bridge these gaps, allowing individuals to receive mental health services remotely. However, the provision and utilization of telemental health services varies across healthcare settings and states due to differences in policies, technology access, and provider readiness.

This dissertation explores how telehealth services and policies impact mental health care access and use. The first study examined the effect of providing telemental health service in Federally Qualified Health Centers (FQHCs), which provide care to many low-income and Medicaid patients. Results show that telemental health service provision increased mental health visits, particularly for depression and anxiety. The second study looked at state Medicaid policies on reimbursement for telephone-only (audio-only) mental health services in FQHCs. While this policy did not increase overall visit rates, it improved access for FQHCs that did not already have an established telehealth service, showing that telephone-based services can help fill care gaps where video telehealth is not an option. The third study explored how state telehealth policies affect hospital adoption of telepsychiatry. The findings suggest that removing restrictions on where Medicaid patients can receive telepsychiatry helped more hospitals offer these services. Additionally, policies that allow mental health providers to work across state lines showed a positive impact overtime, while financial incentives like private parity and audio-only coverage benefited hospitals serving more psychiatric patients.