Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study (Preprint)

Abstract

BACKGROUND The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. OBJECTIVE The aim of the present study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. The authors hypothesized that there would be an increase in the number of patients seen in-person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. METHODS The present study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Timepoint 1) at a one-year follow-up in spring 2021 (Timepoint 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veteran’s Affairs hospital). RESULTS From Timepoint 1 to Timepoint 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (81% to 87%, p = 0.01) and there was a significant decline in cancelled/rescheduled appointments (25-50% in 2020 to 3-7% in 2021, p < 0.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (p < 0.001) and providers working at AMCs and private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (p < 0.001). The percent of time working remotely decreased overall (78% to 59%, p < 0.001), which was most notable amongst neuropsychologists and providers working at an academic medical center. There was an overall increase in the number of patients seen in-person per week compared to earlier in the pandemic (4.3 to 8.7, p <0.001), with no change in the number of patients seen via telehealth (9.7 to 9.9, p = 0.66). CONCLUSIONS These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in-person. While more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.