Telemental Health Surges for Schizophrenia Care Post-COVID, Racial Gaps Persist

Sharon-Lise Normand, PhD

Credit: Harvard Medical School

A new study found telemental health care diffused rapidly after the onset of the COVID-19 pandemic among Medicaid beneficiaries with schizophrenia.¹

“Our study shows that after the onset of the COVID-19 pandemic, telemental health care diffused rapidly to deliver care to Medicaid beneficiaries with schizophrenia across New York’s state-licensed mental health agencies,” wrote investigators, led by Sharon-Lise Normand, PhD, from the department of health care policy at Harvard Medical School. “This is evidenced by most agencies having reached the diffusion target indicating routine use in less than 3 weeks, which may be an adequate spacing of visits for individuals with acute presentations of schizophrenia.”

Receiving mental health care through telehealth increased after the COVID-19 pandemic onset. A study last January found that mental health video visits have had consistent increases since the COVID-19 pandemic peak around May 2021.² Although many people utilize these services, not much is known about the speed of adoption of telemental health care for individuals with schizophrenia.

Investigators sought to characterize telemental health care diffusion in mental health agencies treating Medicaid beneficiaries with schizophrenia, as well as the association of telemental health care use with race and ethnicity.¹ They conducted a retrospective study using New York State Medicaid data from March 1, 2019, to February 29, 2020 (pre-pandemic period), and from March 11, 2020, to March 31, 2021 (pandemic period) from 261 agencies serving 30,990 beneficiaries with schizophrenia who had ≥ 1 mental health visit during the pandemic period.

Investigators collected data on agency type (freestanding, hospital-affiliated, or state-operated), race, and pandemic severity, determined by COVID-19 hospitalization rates per a 10,000 population. The primary outcomes were the days to 10% cumulative telemental health care use within agencies, time to the first telemental health care visit, and telemental health care visit in catchment areas.

The analysis examined 261 agencies (18 state-operated, 79 hospital-affiliated, and 164 free-standing) and 30,990 beneficiaries with schizophrenia. The sample had a mean age of 43 years, 59% male, and a race breakdown of 38% Black, 25% White, 20% Latinx, and 7% Asian or other.

95% of agencies (n = 248) reached 10% cumulative telemental health care visits in a mean of 18 days. 2% of agencies (n = 6) never adopted telemental health care.

Investigators found participants in racial or ethnic minority groups (23%) were not linked to telemental healthcare diffusion in the pre-pandemic period. Compared to White participants, the time to first telemental health care visit was slower in participants who were Asian or other (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.88 – 0.98), Black (HR, 0.90; 95% CI, 0.87 – 0.93), Latinx (HR, 0.95; 95% CI, 0.91 – 0.99).

Beneficiaries from a racial or ethnic minority group were less likely than White participants to have a telemental health care visit regardless of pandemic severity and area. However, there were fewer differences when pandemic severity was greater (HR, 0.70; 95% CI, 0.63 – 0.79), such as in New York City, but more differences when pandemic severity was low (HR, 0.59; 95% CI, 0.53 – 0.67). At times of high pandemic severity, Black people were more likely to have a telemental health care visit.

The team observed race and ethnicity differences in healthcare systems with varying levels of stress. The differences were more prominent when the severity of schizophrenia was greater, showing that vulnerable groups may be prioritized when the healthcare system is under stress.

The study also revealed diffusion was quicker in state-operated than free-standing agencies (hazard ratio [HR], 2.44; 95% CI, 1.21 – 4.95). Investigators theorized this may be because state-operated agencies are more familiar with state government procedures, leading to rapid implementation of new state policies and regulations.

Hospital-affiliated agencies were slower to adopt telemental health care, and the team believed this could be because free-standing agencies were smaller, more vertically integrated, and had a more cohesive workforce focused on mental health care.

“Although these features may not be easy to replicate across all mental health care provider organizations, greater administrative and workforce integration is a desirable feature for any organization,” investigators concluded.

References

1. ^{Race and Ethnicity and Diffusion of Telemedicine in Medicaid for Schizophrenia Care After Onset of the COVID-19 Pandemic. JAMA Network Open. 2025;8(1):e2454776. doi:10.1001/jamanetworkopen.2024.54776.}
2. ^{Derman, C. Telemedicine Reduced After COVID-19 Peak, Mental Health Video Visits on Rise. HCPLive. January 24, 2024. https://www.hcplive.com/view/telemedicine-reduced-after-covid-19-peak-mental-health-video-visits-rise. Accessed January 16, 2025.}