Evaluating the Impact of a National Telehealth Outpatient Mental Health Program in Rural Communities

Limited data exist on care delivery, engagement, and clinical outcomes among rural populations accessing telehealth mental health services, particularly within integrated psychotherapy-and-psychiatry models. This retrospective observational 12-week cohort study aimed to examine access, engagement, and preliminary clinical outcomes for rural and non-rural patients receiving services through a national outpatient telehealth mental health program. Engagement and clinical outcomes were expected to be comparable among rural and non-rural patients.

Descriptive and inferential analyses were conducted to examine access to care, engagement, and changes in depressive symptoms, anxiety symptoms, and suicidal ideation among rural and non-rural patients receiving telehealth mental health services over a 12-week treatment period. Clinical outcomes were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). The full sample included 8354 rural and 177,864 non-rural patients and was used to assess access and engagement in treatment. A clinical sample (rural n = 2096; non-rural n = 43,067) that included patients who completed 12 weeks of care was further examined to assess symptom improvement outcomes.

Rural patients demonstrated greater baseline symptom severity and medical complexity relative to non-rural patients. Mean time to first appointment was 5.2 days among rural patients and 5.5 days among non-rural patients, with comparable engagement across groups and rural patients averaging approximately 1-2 touch points per week in care. Patient satisfaction ratings averaged 4.9 out of 5. Within the clinical sample, rural patients demonstrated clinically meaningful symptom improvement across depression and anxiety outcomes. Mean PHQ-9 scores improved by 7.0 points (95% CI: 6.72-7.28), and mean GAD-7 scores improved by 6.1 points (95% CI: 5.83-6.37). Additionally, 70.5% of rural patients achieved a minimal clinically important difference in PHQ-9 or GAD-7 scores, and 66.7% of patients reporting suicidal ideation at baseline no longer endorsed suicidal ideation at endline.

These findings support the feasibility and preliminary effectiveness of large-scale virtual mental health care models for rural populations. Rural patients demonstrated engagement and clinical outcomes comparable to non-rural patients despite greater baseline severity and medical complexity.