Virtual Progress, Real Inequities

When COVID-19 upended the U.S. health care system, few areas saw as much transformation as mental health care. Telehealth became a widespread modality for behavioral therapy, medication management, and psychiatric consultations. Adopters and advocates heralded this shift as a democratizing force; by removing geography as a barrier, virtual care could finally reach those who had long been underserved, including people of color and rural populations. Yet, as Boswell and colleagues show in this issue, much of this promise remains unrealized.

Leveraging data from the 2021-2022 National Survey on Drug Use and Health, the authors examined mental health service use among more than 92,000 U.S. adults. Among their findings: non-Hispanic Black and Hispanic adults were significantly less likely than non-Hispanic White adults to receive any mental health care—including outpatient, prescription, and telehealth services. Although rural residents were as likely as urban dwellers to receive in-person care, they were also less likely to receive telehealth services. In short, the digital transformation of mental health care has left many of the same underserved communities behind.