We know that health disparities exist for physical health and there’s mounting evidence that the same is true for mental health. Mental health and physical health are intertwined, and both are needed to achieve whole health.
That’s why, in a State of the Nation’s Mental Health special report, we researched how people of color fared for two six-month periods before COVID-19 and during COVID-19. We wanted to understand if COVID-19 intensified those disparities, and how telehealth visits – through the use of telephone or video – played a role, since this was how many of us connected with our health care providers during 2020. Telehealth was used by an incredible 49 percent of all Medicaid mental health visits from March 1, 2020 to Aug. 31, 2020 by members who already had at least one mental health visit.
The good news: COVID-19 didn’t exacerbate differences in mental health equity. And, for at least one group, telehealth seemed to help.
The bad news: Differences still existed and during a time when people of color were experiencing more stress and mental health conditions than other populations and were disproportionately impacted by the virus.
A higher percentage of Hispanic/Latinos were already receiving in-person or telehealth mental health visits before COVID-19. By greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions – especially with Hispanics/Latinos. In fact, during COVID-19, almost 40 percent of Hispanic/Latino members had a telehealth visit, while White members had 34 percent, Asian members had 33 percent and Black members had 28 percent.
While telehealth did boost visits during COVID-19, it didn’t make up for the dramatic drop in in-person visits for all races and ethnic groups. And there were significant differences among them. In fact, Black people had the lowest percent of combined telehealth and in-person visits – 56 percent – before COVID-19 and remained the lowest with 49 percent after COVID-19.
On average, Black people had 7 percent fewer mental health visits compared to White people with similar demographic, clinical and socio-economic backgrounds.
There are many reasons behind the differences in mental health care visits we researched. Historically, major depression and anxiety are underdiagnosed at rates of 32-40 percent less in Black and Hispanic/Latino communities, according to the BCBS Health Index. The American Psychological Association says that lower diagnosis rates are likely driven by lack of provider understanding of cultural differences, stigma around diagnosis or treatment and barriers getting care.
What are the implications of this research?
Telehealth isn’t a panacea in eliminating health equity gaps but it did seem to help us maintain some normalcy during a time when physical doors to therapy were temporarily closed. And while technology alone won’t be sufficient to bridge these differences, the differences likely won’t be the same for all people.
We will continue to explore gaps and advance progress in areas we believe we can make a difference – checking in with our data to see how these efforts are moving the needle toward greater health equity and whole health. Some of these efforts include:
- Social drivers of health benefits that can assist in improving health equity for physical and mental health.
- Peer programs, such as those offered by Anthem and Beacon, may also help create trust by pairing members with someone who has the same lived experience.
- Education and informative efforts that involve connections to trusted sources, like churches and even barbershops, have been shown to have greater impact on community acceptance of health services.
- Continuing Medical Education programs, such as mydiversepatients.com, that train clinicians about bias and cultures different from their own, and go a long way in creating stronger, more trusting and culturally responsive relationships between clinicians and patients.
Anthem supports making permanent many of the telehealth policy changes that have occurred during COVID beyond the public health emergency. These include legislative and regulatory policies that:
- Allow consumers to see doctors or clinicians from their home.
- Allow providers with appropriate medical licensure to deliver services across state lines, and
- Eliminate pre-COVID-19 policies that placed prohibitions on prescribing medications via telehealth.
CMS recently announced that it is expanding access to mental health care and reducing barriers to treatment by proposing rules that would continue to allow telehealth coverage for Medicare members for diagnosis, evaluation and treatment of mental health disorders.