Trends in Mental Health Utilization Before and During the COVID-19 Pandemic: Federally Qualified Health Centers As a Case Study

This study examined differential mental health utilization patterns before and during the COVID-19 pandemic. Data were obtained from 12 Federally Qualified Health Center (FQHC)-behavioral health clinics and included 65,561 visits between February 2019 and November 2020 for adults aged 18-64 years. To allow for a year-over-year comparison, the pre-COVID-19 period was flagged as visits between February 2019 and November 2019 and the peri-COVID-19 period as visits between February 2020 and November 2020. A difference-in-difference model with Poisson regression was used to predict racial/ethnic differences in the number of visits between the pre- and peri-COVID-19 periods. Overall, the average number of visits per patient increased from 5.45 visits in the pre-COVID period to 5.78 visits in the peri-COVID-19 period. Hispanics had +0.6 visits, Blacks had +0.3 visits, and other racial groups had +0.9 visits during the peri-COVID-19 period than the pre-COVID-19 period. In contrast, Whites (-0.6 visits) and Asians (-1.7 visits) were less likely to use mental health services in these FQHC clinics in the peri-COVID-19 period as compared with the pre-COVID-19 period. Peri-COVID-19 utilization rates were significantly higher for virtual visits (incident-rate ratio [IRR] = 1.15, P < 0.01) and residence in a metropolitan area (IRR = 1.14, P < 0.01), but lower for persons aged 55+ years (IRR = 0.92, P < 0.01) and males (IRR = 0.87, P < 0.01). Racial/ethnic minority patients, except Asians, were more likely to use mental health services during the COVID-19 pandemic than in the preceding year. This may be attributable to policy changes such as the CARES Act, which expanded health care access options to include telemedicine.