OBJECTIVES

: To estimate the adoption of Tele-mental health (TMH) and examine the associations of facility-level and state-level factors with TMH adoption among US mental health (MH) facilities.

METHODS

: This retrospective, cross-sectional study used linked data from several sources: 1) 2016 National Mental Health Services Survey; 2) 2016-2017 Area Health Resources File; and 3) 2016 national reports of broadband access and telehealth policies. Analyses included 11,883 MH facilities located in the 50 states and Washington DC. We examined the associations of facility-level [facility type, comprehensiveness of treatments, Quality Improvement (QI) practice, Information Technology (IT) capacity, payer and patient mix] and state-level (policy, market, and environmental resources) characteristics with TMH adoption using multi-level logistic regressions, adjusting for clustering of states.

RESULTS

: In the US, 25.9% of MH facilities adopted TMH. Having and high IT capacities [AOR (95%CI): 2.89 (2.10-3.98)] were the strongest factors associated with adoption. Other significant facility characteristics included: having outpatient settings, public ownership, high patient volumes, comprehensive MH treatments, QI practices, private or non-Medicaid public payers, and treating elderly patients. TMH adoption was significantly less likely among facilities treating more African Americans or patients with substance use disorders. TMH adoption varied substantially across states (3.4% in Connecticut to 68.8% in North Dakota). Adoption was significantly more likely in states issuing special telehealth licenses [AOR (95%CI): 2.24 (1.16-4.32)] and those with more rural counties (AORs: 2.09-2.36).

CONCLUSIONS

: One in four MH facilities adopted TMH in 2016. TMH adoption varied by multiple facility- and state-level factors. Our findings suggest that policy initiatives that: reduce legal/regulatory burden and expand IT capacity for facilities may increase TMH adoption; racial disparities in TMH access warrant further attention; and there is a need for targeted efforts to increase TMH use for substance use disorders.