Telemental Health Disparities and the Role of Access in Underserved Communities

In part 2 of an interview with The American Journal of Managed Care® (AJMC®), Xin Hu, PhD, MSPH, assistant professor at Emory University School of Medicine, delves deeper into the findings of her study, "Racial and Ethnic Disparities in Telemental Health Use Among Publicly Insured Children," published in the March 2025 AJMC issue.

Watch part 1 for an overview of the study's background, objectives, and key findings.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Despite the 12-fold relative increase in telemental health use after the onset of the COVID-19 pandemic, there were still significant disparities in use across racial and ethnic groups. What do you believe were the key factors contributing to these disparities?

I think there are multiple factors that likely contributed to these disparities in telemental health use. For example, this could be due to cultural or personal preference for in-person engagement. Some minority groups may experience access barriers to home broadband required for telemental health. Some minority groups, such as Hispanic and Asian populations, may experience language barriers.

It may also be due to historic mistrust in the mental health system among some of these racial and ethnic minority groups, and given that physical interaction with your provider is very important to build patient-provider trust, the fact that, usually, there's an absence of physical interaction through telemental health could further magnify the mistrust among racial and ethnic minority groups.

The disparities we found by county level and racial and ethnic composition also review the broader systemic barriers to telemental health. For example, it's possible that the mental health providers serving communities with a higher percentage of Black and Hispanic residents have fewer resources and were less able to pivot to telemental health effectively at the onset of COVID-19.

Your study found that telemental health use was higher in mental health provider shortage areas and rural regions. What does this suggest about its role in improving access to care in underserved communities?

We know that children in rural and mental health provider shortage areas often face logistic challenges in accessing in-person care. What we found is that even before COVID-19, telemental health use was already a little higher in these communities.

We also found that telemental health uptake was greater in these underserved communities after the onset of the pandemic. The COVID-19 pandemic accelerated telehealth adoption through expanding insurance coverage by Medicaid, CHIP [Children's Health Insurance Program], some other private payers, and through health care organization investment in telehealth infrastructure.

Given the potential to bridge gaps in access to mental health, we think that telehealth could be a very valuable tool to address mental health care disparities in these underserved communities.