Utilization of Outpatient Mental Health Services During and 2 Years after the COVID-19 Pandemic

Objective: Analyze the impact of COVID-19 on outpatient mental health (OP-MH) utilization patterns, particularly telehealth, across eight different MH conditions with a 2-year follow-up. Methods: This population-based cohort study uses a 5% random sample of Medicare beneficiaries aged ≥18 and newly diagnosed with one of the eight MH disorders: psychotic, depressive, bipolar, anxiety, trauma-related, substance-use, other MH disorders, and two or more MH disorders. Monthly OP-MH utilization patterns were compared among patients in 2020-2021 newly diagnosed in 2019 to comparable prepandemic cohorts newly diagnosed in 2017. Multiple logistic regression models were conducted to examine differences in telehealth utilization across MH conditions. Results: Across groups, patients were mostly aged 65-84 (n = 39,749 [72.4%] in 2017 and n = 40,513 [75.5%] in 2019), female (n = 33,387 [60.8%] in 2017 and n = 32,193 [60.0%] in 2019), and White (n = 48,314 [88.0%] in 2017 and n = 47,282 [88.1%] in 2019). Total OP-MH utilization dropped (a 27.5% decrease at its lowest) for all MH conditions at the pandemic's onset compared with the nonexposure group. Although utilization increased postpandemic, slight disruptions remained until the end of 2021. Telehealth visits rose from 0.5% in January 2020 to 55% in April 2020, decreasing to 18% by December 2021. Regression analysis showed that patients with psychotic, bipolar, or trauma-related, and two or more MH disorders had higher odds of telehealth usage compared with those with anxiety, while patients with substance-use disorders had lower odds. Rural residents, older adults (65+), and men had lower odds of using telehealth, with residents of the Northeast and West regions showing higher odds compared with the South. Telehealth disparity profiles were uniquely associated with different MH conditions. Conclusion and Relevance: Findings highlight the need for tailored telehealth strategies among Medicare beneficiaries to address specific demographic and geographical disparities across MH conditions.