The need for mental health services has risen sharply since the pandemic, and a growing number of patients have been turning to telehealth services to get the care they need. But many people in rural Pennsylvania do not have access to these services due to a lack of broadband access.
A team of researchers has been looking into the geographical disparities in access to mental telehealth care: Bhav Jain is a Pittsburgh native and currently studying medicine at Stanford University, and Dr. Hatice "Nur" Eken is a psychiatry resident at UPMC. They spoke to 90.5 WESA's Priyanka Tewari on Morning Edition.
Priyanka Tewari: What made you want to look into the lack of tele mental health care in rural areas? And why now?
Bhav Jain: What sparked this work across our group was a big hope that emerged out of Covid — that accessing and leveraging telehealth as a mode of health care delivery would actually improve access.
What we end up showing is that it's the same counties who have actually reduced broadband access, who are nearly three times as likely to have no mental health physicians and no outpatient facilities, and also twice as likely to have no psychiatric or substantive use hospitals as those counties who have increased broadband access.
Tewari: Are there any programs that exist right now that are a good starting point for improving access and care?
Jain: The major program is the A.C.P., which stands for the Affordable Connectivity Program. This is a program that's able to give people $30 a month off of their bills. But if you look at a state like Pennsylvania, under 40% of eligible participants are actually enrolled in this federal benefit. The interesting aspect is that the A.C.P. has a much higher uptake in urban areas, but the parts of the state and the country which need the A.C.P. are the lower income rural areas.
Tewari: Even if people have internet access, is there a mental health provider shortage right now?
Eken: Oh, absolutely. There has been for a while, and certainly especially in the rural areas, we have incredible gaps. A lot of communities will only have a primary care provider without a psychiatrist, and will have individuals suffering from severe mental health diseases, like psychosis and bipolar disorder, that the physicians won't necessarily feel comfortable taking care of.
Tewari: Do feelings of isolation in rural areas make the need for telehealth even more acute? Is there a stigma, still, surrounding mental health?
Hatice Eken: Certainly, I think one of the things that came out of the pandemic was increased awareness of mental health issues, especially depression and anxiety. [It's been] getting more coverage in social media, as well. So it's better in terms of like how we approach mental health. But stigma, especially in rural communities, is certainly still a problem.
Jain: I'll also add that recent studies do seem to suggest that individuals in rural areas have nearly a 30% higher rate of social isolation than their counterparts in urban areas. That, paired with the fact that it's just so much harder to actually access any form of health care across rural areas, whether it's telehealth or physical health, all of these issues end up simply compounding on top of each other.
Tewari: was there anything that surprised you as you were conducting this research?
Jain: I think what most surprised me is that there were a number of counties actually extremely close to our home of Pittsburgh, which are experiencing low access to broadband and low access to mental health specialists. It's places like Armstrong County, places like Somerset and Clarion Counties. I did not expect going in that these areas might end up being so close to home.
Eken: Not necessarily surprising, but I think as you were mentioning before, it was concerning to realize that a lot of the individuals we thought we were reaching via virtual means, we were unable to.
Research on "The digital divide in access to broadband internet and mental healthcare" was recently published in Nature Mental Health.
