Research has shown that the online therapy boom has benefited mainly privileged groups

The number of Americans receiving psychotherapy has increased by 30 percent during the pandemic as virtual sessions replaced in-person visits, but recent research is dampening hope that technology will make mental health care more accessible to populations most in need.

In fact, researchers found, the shift to teletherapy has exacerbated existing disparities.

The raise in psychotherapy occurred among groups that already enjoyed greater access: people with higher incomes, those living in cities, those with stable employment and higher education, as researchers found in a series of studies, the most recent of which was: published on Wednesday in The American Journal of Psychiatry.

The team found that those who did not benefit from the boom included children from low-income families, black children and adolescents, and adults with “sedate mental health problems.”

“I think the whole system of care — and maybe internet access is part of it — seems to be shifting attention away from the people who are most in need,” said Dr. Mark Olfson, a professor of psychiatry at Columbia University Irving Medical Center and lead author studies on access to care.

“We’re seeing that people experiencing the most anxiety are losing ground in terms of their likelihood of getting treatment, which to me is a very critical and concerning trend,” he added.

This wasn’t supposed to be like this. In the 1990s, teletherapy was promoted as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. Ten years later, they were presented as a more accessible alternative to face-to-face sessions that could dramatically lower barriers to care.

“Telehealth has fallen low of expectations,” said C. Vaile Wright, senior director of the Office of Health Care Innovation at the American Psychological Association. She added that the reasons are not surprising: Many Americans do not have access to reliable broadband, and insurers do not adequately reimburse providers, who in turn choose to treat privately paying customers.

“If you can’t afford it, regardless of the method, you just can’t afford it,” Dr. Wright said. It may be the case, she added, that weekly therapy sessions simply cannot cover a broad population, and gentle alternatives such as single-session interventions and digital therapy should be explored in this area.

As telehealth platforms expand, they may attract community-based clinicians with the promise of versatile hours and better conditions, said Dr. Jane M. Zhu, an associate professor of medicine at Oregon Health and Science University who studies the availability of mental health services.

By selecting from a vast pool of patients, they can choose to treat patients with milder conditions and a greater ability to pay. “It’s certainly something we should know,” Dr. Zhu said. “There should be lithe around it. Who do these companies serve? And what does this mean for the most vulnerable patients?”

Percentage of Americans using psychotherapy remained relatively constantat 3 to 4 percent for decades before beginning a gradual raise, Dr. Olfson said.

Then, two factors – the pandemic and the explosion of teletherapy – contributed to a keen raise, and the number of adults using psychotherapy rose to 8.5%. in 2021 from 6.5 percent in 2018 (For comparison, the annual percentage of adults taking psychotropic medications remained stable, approximately 17.5 percent.)

Dr. Olfson said he was surprised by the scale of the raise. “We haven’t had anything like Covid before and we haven’t had this technology before,” Dr. Olfson said. “There was a lot of social isolation, a lot of loneliness. And it is these problems that psychotherapy aims to address in a way that drugs cannot.”

The findings are based on the federal government’s Medical Expenditure Panel study of how U.S. civilians operate and pay for health care. The study does not include people in the military, prisons, nursing homes, hospitals or homeless shelters.

Previous research, based on insurance data, found that Americans’ mental health spending increased 54 percent from 2020 to 2022, with a tenfold raise in the operate of teletherapy.

Recent research explains which Americans receive this care. Analysis of 89,619 adults published last month in JAMA Psychiatry found that psychotherapy operate increased most among the youngest respondents, the most educated, and those in the two highest income brackets.

Some analysis of telehealth use children and adolescents from 2,445 households reached similar conclusions. A study published today shows that children from wealthier families with private insurance are much more likely to operate teletherapy. Children from urban areas used it almost three times more often than their peers from rural areas.

During the pandemic years, the operate of mental health services among Black children and adolescents dropped to 4%. in 2021 from 9.2 percent in 2019. During the same period, the operate of mental health care among white children increased to 18.4%. from 15.1 percent, the team found in another study.

“What we found is that it actually seems to only exacerbate existing disparities,” Dr. Olfson said. “I think we really need to try to solve this problem.”