Latinos Embraced Remote Mental Health Visits Amid Pandemic

By greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions.

Latinos were the most engaged in using remote mental health services during the height of the pandemic in 2020, according to a new analysis commissioned by Anthem Inc.

The study -- Anthem, Inc.  State of the Nation’s Mental Health – looked at Medicaid trends in 14 states in 2020 and found that, for people with existing mental health conditions, telehealth access to rose precipitously for all races and ethnic groups during the pandemic and accounted for 49% of all Medicaid mental health visits during a six-month period in 2020.

The study speculates that by greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions – especially with Hispanics/Latinos.

"In fact, during COVID-19, almost 40% of Hispanic/Latino members had a telehealth visit, while White members had 34%, Asian members had 33% and Black members had 28%, the study said.

"Overall gaps in getting mental health care between races and ethnic groups remained essentially the same before and during COVID," the study said. "A higher percentage of Hispanic-Latinos were already receiving in-person or telehealth mental health visits before COVID-19."

Despite the dramatic boost in telehealth visits during the pandemic, it didn't make up for the dramatic drop in in-person visits for all races and ethnic groups, and the study found there there were significant differences among them.

"In fact, Black people had the lowest percent of combined telehealth and in-person visits – 56% – before COVID-19 and remained the lowest with 49% after COVID-19," the study said.

"On average, Black people had 7% fewer mental health visits compared to White people with similar demographic, clinical and socio-economic backgrounds. The rates are particularly noteworthy as surveys have indicated that people of color were experiencing more stress and mental health conditions than other populations in 2020 and people of color were disproportionately impacted by COVID-19," the study said.

Historically, major depression and anxiety are underdiagnosed at rates of 32%-40% less in Black and Hispanic/Latino communities, according to the BCBS Health Index.

The American Psychological Association says that lower diagnosis rates are likely driven by lack of provider understanding of cultural differences, stigma around diagnosis or treatment and barriers getting care.

Anthem Chief Health Officer, Shantanu Agrawal, MD, said there could be a number of reasons why Black people are lagging in mental health care visits, both in-person, and remote, including a history of "culturally insensitive care."

"Health equity is a key driver for mental and physical well-being," Agrawal said. "To achieve equity in our healthcare, we need to understand where and why barriers to health exist, and then couple these insights with the scale and scope of Anthem to drive changes to a new system of health, that puts equity at the center."

The most common telehealth diagnoses for Medicaid members with existing mental health conditions were anxiety, depression and bipolar disorder, according to the special State of the Nation’s Mental Health report. High blood pressure was among the top five diagnoses for Black, Asian and Hispanic/Latino people, while high cholesterol was a top five medical diagnosis for Hispanic/Latino and Asian people. Opioid use disorder was one of the top five diagnoses for White people, while severe back pain was a top diagnosis for Black people. These data reinforce that mental health and physical health are connected and improving one can help the other.

"While telehealth wasn't a panacea in eliminating health equity gaps, it helped boost connectivity for all and made Internet visits possible when COVID temporarily closed physical doors, allowing health care to continue to be delivered with some semblance of normalcy," Agrawal said.

"This study is a key reminder that technology alone won't be sufficient to bridge this gap and the bridge may not be the same for all people. However, it may be the connector needed by certain communities or geographic areas. Clearly, outcomes during the pandemic would have been much worse without telehealth," he said.