Patient and provider predictors of telemental health use prior to and during the COVID-19 pandemic within the Department of Veterans Affairs.

This study investigated the demographic and clinical factors influencing the use of phone, video, and in-person mental health (MH) services within the Department of Veterans Affairs (VA). Using national data from millions of patients and thousands of providers, the researchers compared utilization patterns during the pre-pandemic period (October 2017 to March 2020) and the initial phase of the COVID-19 pandemic (March 2020 to July 2020). The analysis focused on identifying who was most likely to engage in video-based care and who relied on other modalities, such as phone or in-person visits.

The COVID-19 pandemic triggered a massive shift in how mental health care was delivered. While in-person visits dominated the pre-pandemic landscape, phone-based care became the most common modality during the pandemic. Despite this shift, the study identified a clear digital divide. Older patients (aged 50+) and those with lower socioeconomic status were consistently less likely to use video platforms. Conversely, female patients were more likely to utilize video services.

Provider-level data revealed that psychologists were significantly more likely to use video than psychiatrists, other medical providers, and non-medical providers. This may be due to differences in caseload management and the nature of the clinical work performed by these disciplines. Additionally, older providers were less likely to adopt video-based care, suggesting that technological comfort and training are significant barriers to implementation.

Understanding these disparities is essential for ensuring equitable access to mental health services. As healthcare systems increasingly integrate telehealth, identifying the barriers that prevent specific populations from accessing video care—such as age, income, and provider discipline—is critical. The findings suggest that simply providing technology is not enough; targeted training and support for both patients and providers are necessary to bridge the digital divide and ensure that the most effective, evidence-based care modalities are available to all patients, regardless of their background or clinical needs.