Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Gen Hosp Psychiatry. Nov-Dec 2020;67:100-106. doi: 10.1016/j.genhosppsych.2020.09.004. Epub 2020 Oct 12.


Objective: To examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening.

Methods: Observational study of outpatient MH/SUD visits January 1st-June 30th, 2018-2020 by: 1) visit diagnosis group, 2) provider type, 3) patient race/ethnicity, 4) insurance, and 5) visit method (telemedicine vs. in-person).

Results: Each year, January-June 52,907-73,184 patients were seen for a MH/SUD visit. While non-MH/SUD visits declined during the surge relative to 2020 pre-pandemic (-38.2%), MH/SUD visits increased (9.1%)-concentrated in primary care (35.3%) and non-Hispanic Whites (10.5%). During the surge, MH visit volume increased 11.7% while SUD decreased 12.7%. During partial reopening, while MH visits returned to 2020 pre-pandemic levels, SUD visits declined 31.1%; MH/SUD visits decreased by Hispanics (-33.0%) and non-Hispanic Blacks (-24.6%), and among Medicaid (-19.4%) and Medicare enrollees (-20.9%). Telemedicine accounted for ~5% of MH/SUD visits pre-pandemic and 83.3%-83.5% since the surge.

Conclusions: MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine. Despite this, widening diagnostic and racial/ethnic disparities in MH/SUD visit volume during the surge and reopening suggest additional barriers for these vulnerable populations, and warrant continued monitoring and research.

Keywords: COVID-19; Disparities; Health care systems; Mental health; Substance use disorders.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / statistics & numerical data*
  • COVID-19 / prevention & control*
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Massachusetts
  • Medicaid / statistics & numerical data
  • Medicare / statistics & numerical data
  • Mental Disorders / therapy*
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Office Visits / statistics & numerical data*
  • Substance-Related Disorders / therapy
  • Telemedicine / statistics & numerical data*
  • United States
  • Whites / statistics & numerical data
  • Young Adult