Telemedicine Boom Fails to Improve Rural Mental Health Access

Study finds telemedicine use by mental health specialists did not significantly increase care for patients in underserved areas.

Published on Mar. 6, 2026

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A new study from researchers at Brown University, Harvard Medical School, and McLean Hospital found that the increased use of telemedicine by mental health specialists during the COVID-19 pandemic did not substantially improve access to care for patients in rural or underserved areas. The analysis of Medicare billing records showed that even providers who used telemedicine heavily only saw slightly more patients from these communities compared to those who used it less. The researchers say policy changes, such as making it easier for clinicians to practice across state lines, are needed to ensure telemedicine reaches the populations that need it most.

Why it matters

Access to mental health care has long been a challenge in rural and underserved areas due to a shortage of providers. The COVID-19 pandemic led to a rapid shift to telemedicine, raising hopes that virtual visits could help bridge this gap. However, this study suggests that simply offering telemedicine does not automatically translate to improved access, highlighting the need for targeted policy interventions to address the underlying barriers.

The details

The researchers analyzed Medicare billing records from 2018 to 2023 for 17,742 mental health specialists, grouping them based on their level of telemedicine use. They found that compared to specialists who used telemedicine less, those who used it heavily only saw about 0.9 percentage points more patients from rural areas, 0.1 percentage points more from areas lacking mental health providers, and 2.6 percentage points more from locations 20 miles or more away. The modest increases were primarily due to existing patients who moved and continued care via telemedicine. The study also found that heavy telemedicine users saw 3.6 percentage points fewer new patients overall, suggesting it can reduce providers' capacity to take on new clients.

  • The study analyzed Medicare billing records from 2018 to 2023.

The players

Brown University School of Public Health

The institution where the lead researcher, Drew Wilcock, is based.

Harvard Medical School

The institution where the lead study author, Jacob Jorem, is from.

McLean Hospital

A psychiatric hospital affiliated with Harvard Medical School that was involved in the research.

Drew Wilcock

A lead research scientist at Brown's School of Public Health and a study author.

Jacob Jorem

The lead study author from Harvard Medical School.

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What they’re saying

“We had thought the dramatic shift from in-person care to telemedicine among mental health specialists would lead to them caring for substantially more patients in rural communities. Unfortunately, we just don't see it.”

— Drew Wilcock, Lead Research Scientist, Brown University School of Public Health

“Currently, it is too administratively burdensome for a mental health physicians to get a license in many states. By changing how states license clinicians and making it easier for them to practice across state lines, this could help specialists reach more patients in rural communities.”

— Jacob Jorem, Lead Study Author, Harvard Medical School

“The potential of telemedicine can't be ignored. But simply offering telemedicine will not address the barriers that many rural patients face in obtaining mental health care. For telemedicine's potential to be reached, we need policy interventions to address those barriers. Improving how we license physicians is a critical first step.”

— Ateev Mehrotra, Professor of Health Services, Policy and Practice, Brown University

What’s next

Researchers hope the findings will prompt action from legislators and practitioners to implement policy changes that make it easier for mental health providers to practice across state lines, in order to improve access to telemedicine services in rural and underserved areas.

The takeaway

While telemedicine has the potential to expand access to mental health care, simply offering virtual visits is not enough to overcome the longstanding barriers that rural and underserved communities face. Targeted policy interventions, such as streamlining licensing requirements for clinicians, are needed to ensure telemedicine reaches the populations that need it most.