Mental health care access remains uneven across the United States, especially between urban and rural areas. Over the last few years, telemedicine has been promoted as a promising solution to bridge these gaps. Many policymakers and healthcare leaders expected remote mental health services to connect specialists with patients who live far away or in areas with limited care options.
However, new research suggests the impact may be more limited than anticipated. A recent cohort study published in JAMA Network Open (2026) examined how telemedicine adoption among mental health specialists affects the geographic distribution of their patients. The findings provide valuable insights into whether telepsychiatry truly improves access for underserved communities.
This article summarizes the research, explores its implications for healthcare policy, and explains what it means for patients, providers, and policymakers.
Telemedicine has transformed many aspects of healthcare, but mental health services have seen some of the most significant changes. During the COVID-19 pandemic, restrictions on in-person visits pushed providers and patients toward virtual consultations. Mental health care was particularly well suited for remote delivery because therapy and psychiatric consultations can often occur through video or phone calls.
By 2021, more than one third of mental health visits in the United States were conducted remotely. Some clinicians even transitioned entirely to virtual practice models.
The expectation was straightforward. If specialists could connect with patients online, geographical barriers would become less important. Patients living in rural areas or communities without local specialists could receive treatment without traveling long distances.
Despite this optimistic outlook, there has been limited evidence showing whether telemedicine actually expands access for these populations.
Researchers conducted a large cohort study using Medicare fee for service claims data from 2018 to 2023. The goal was to evaluate whether mental health specialists who adopted telemedicine more extensively treated more patients from rural or underserved areas.
The study included 17,742 mental health specialists, such as:
These clinicians were grouped based on how frequently they used telemedicine in 2021.
Researchers divided providers into four groups according to the percentage of visits conducted via telemedicine:
This approach allowed the researchers to compare specialists who relied heavily on telemedicine with those who primarily delivered in person care.
The study examined whether higher telemedicine use was associated with treating more patients who:
Researchers also evaluated whether telemedicine affected the number of new patients entering care versus existing patients continuing treatment.
The results showed that telemedicine adoption was associated with only small changes in where patients lived.
Providers who relied most heavily on telemedicine saw a slightly higher proportion of patients living in rural areas.
However, the increase was small. By 2023, the highest telemedicine group had less than a one percentage point increase in visits with rural patients compared with the lowest telemedicine group.
This suggests telemedicine alone did not dramatically expand access to mental health specialists for rural populations.
Telemedicine was associated with modest increases in patients living farther from their providers.
For example, specialists with the highest telemedicine use experienced a 2.62 percentage point increase in visits with patients who lived at least 20 miles away compared with specialists who used telemedicine less often.
Although this indicates some expansion of geographic reach, the change remained relatively limited.
The study also evaluated whether telemedicine allowed specialists to treat patients in other states.
The increase in cross state visits was again small. Researchers found less than a one percentage point difference between the highest and lowest telemedicine adoption groups.
This result likely reflects regulatory barriers, including state licensing requirements that limit cross state practice.
One surprising finding was that specialists who relied heavily on telemedicine treated fewer new patients.
Compared with lower telemedicine users, providers with the highest adoption rates saw about 3.5 percentage points fewer new patients over time.
This suggests telemedicine may improve continuity of care for existing patients but might reduce the number of openings for new individuals seeking treatment.
The study highlights several factors that may explain why telemedicine adoption did not substantially increase care for rural or underserved populations.
Many specialists continued treating their existing patients through telemedicine rather than expanding to new populations. Remote care made it easier for these patients to stay connected with providers, even if they moved farther away.
In fact, the researchers found that a large portion of the geographic changes occurred because existing patients relocated, not because specialists added new rural patients.
Demand for mental health care has grown significantly in recent years. Many specialists already have full schedules and waiting lists.
Because of this high demand, providers may not need to actively seek new patients from distant communities. Instead, they continue serving individuals within their established referral networks.
Technology barriers also play a role. Many rural communities lack reliable broadband internet, which is necessary for video based telehealth visits.
Even when phone based services are available, limited internet infrastructure can discourage telemedicine use.
Some patients may also face challenges using digital health platforms. Older adults and individuals with limited technology experience may struggle to navigate telehealth systems.
Privacy concerns can also discourage participation, especially for patients who do not have a private space for therapy sessions at home.
State licensing laws may restrict mental health specialists from providing care to patients across state lines. Although temporary policy changes during the pandemic expanded telehealth flexibility, many restrictions remain.
These regulatory barriers limit the ability of telemedicine to expand access across regions.
The study suggests that telemedicine alone is unlikely to solve mental health access disparities. Instead, targeted policy interventions may be necessary to ensure that remote care benefits underserved communities.
Expanding high speed internet access in rural areas is essential for telehealth adoption. Without reliable connectivity, telemedicine cannot reach many of the communities that need it most.
Policies that allow clinicians to practice across state lines could expand access to specialists. Interstate licensing agreements or federal frameworks could help remove regulatory barriers.
Health systems could develop structured referral pathways connecting rural clinics with urban mental health specialists who offer telemedicine services.
This approach could help patients find providers outside their immediate geographic area.
Reimbursement policies may also influence provider behavior. Offering higher reimbursement rates for telemedicine visits with rural patients could encourage specialists to treat more individuals in underserved areas.
For many patients, telemedicine still offers important benefits.
Remote visits can reduce travel time, increase appointment flexibility, and allow individuals to continue seeing their provider after relocating. Telemedicine can also make it easier for people with mobility challenges or busy schedules to receive mental health care.
However, the study shows that technology alone cannot fully address systemic barriers to mental health access.
Improving access will likely require a combination of policy reforms, infrastructure investment, and innovative care models.
Telemedicine will likely remain a major component of mental health care delivery. The pandemic accelerated adoption and demonstrated that remote treatment can be effective for many patients.
Future research may explore how telemedicine can be integrated into broader mental health systems to better reach underserved populations.
Possible strategies include collaborative care models, digital mental health platforms, and partnerships between urban specialists and rural primary care providers.
As healthcare systems continue evolving, understanding the real world impact of telemedicine will be essential for designing policies that improve access for everyone.
The rapid expansion of telemedicine has changed how mental health care is delivered across the United States. While many expected remote services to dramatically increase access for rural communities, new evidence suggests the effect has been modest.
A large cohort study of more than 17,000 mental health specialists found that higher telemedicine adoption was associated with only small increases in visits with rural or distant patients. Much of the geographic change occurred because existing patients moved rather than because providers added new patients from underserved areas.
These findings highlight the need for targeted policies that address infrastructure, licensing, and referral systems. Telemedicine has significant potential, but it must be combined with broader healthcare reforms to truly reduce disparities in mental health care access.
Jorem J, Wilcock AD, Busch AB, et al. Mental Health Specialist Telemedicine Uptake and Patient Location. JAMA Network Open. Published March 5, 2026. doi:10.1001/jamanetworkopen.2026.0823.
This article is for informational and educational purposes only and does not constitute medical, legal, or professional advice. The information summarized here is based on published research and may not apply to all individuals or healthcare systems. Readers should consult qualified healthcare professionals for medical guidance or treatment decisions.
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