Mental Health Specialist Telemedicine Uptake and Patient Location

Wide geographic disparities in mental health care use exist, particularly between rural and urban areas. Telemedicine could enable mental health specialists to reach patients who live farther away in rural communities and communities with low access to care.

To examine the association of the proportion of mental health specialists' visits delivered via telemedicine and the share of their visits to patients living in rural, low-access-to-care, or distant communities.

This cohort study examined Medicare fee-for-service claims for mental health specialist services from January 1, 2018, to December 31, 2023. Specialists were categorized into quartiles based on their 2021 telemedicine uptake (lowest, 0%-40% of visits; low-middle, 41%-79%; middle-high, 80%-98%; highest, 99%-100% of visits). Data were analyzed between November 2024 and December 2025.

Telemedicine use among mental health specialists in 2021.

The main outcome was the proportion of mental health specialists' patients who lived in (1) a rural area, (2) an area with a mental health specialist shortage, (3) a different state from their specialist, and (4) a community 20 miles or more from their specialist. Differential changes in outcomes between specialists in the highest and lowest telemedicine uptake quartiles were estimated using a difference-in-differences framework. A secondary analysis examined the fraction of the changes observed due to established patients moving their residence vs new patients.

The cohort included 17 742 mental health specialists categorized into quartiles based on their telemedicine uptake in 2021. Compared with 2018 and specialists in the lowest telemedicine quartile, specialists with the highest telemedicine use had 0.88 percentage points (95% CI, 0.35-1.39 percentage points) more visits with rural patients in 2023. Similar small changes were observed in the fraction of visits with patients living in mental health specialist shortage areas, in a different state from their specialist, and living 20 miles or more away from their specialist. Specialists with higher telemedicine use visited differentially fewer new patients by 2023 than those with lower use (-3.55 percentage points [95% CI, -5.73 to -1.38 percentage points]).

This cohort study found that greater telemedicine uptake was associated with only small increases in the share of visits to patients in rural, low-access-to-care, or distant communities. Tailored policy interventions may be needed for telemedicine to reach its potential of improving mental health care of individuals with the greatest difficulty accessing it in their local community.