Telehealth expansion during the COVID-19 pandemic partially disrupted mental health service utilization across all cohorts and age groups

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Frontiers in Medicine Published June 2, 2026 Medically reviewed June 2, 2026 Study authors: Emily Lauer, Renata E. Howland, Julie Royer, Jean P. Hall, Noelle K. Kurth, Suzanne L. Hunt, Dawn Wa… DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Note that the COVID-19 pandemic partially disrupted mental health service utilization across all cohorts and age groups.

This meta-analysis evaluates mental health service utilization rates and odds among people ages 1–45 years with intellectual and developmental disabilities (IDD), serious mental illness (SMI), or both. Data were drawn from Medicaid claims in Kansas, Massachusetts, New York, and South Carolina, covering the period from 2018–2019 to 2020–2021. The analysis includes comparisons between cohorts and assessments of telehealth utilization rates, urban-rural differences, and diagnoses driving service use.

Approximately 75% of the IDD/SMI cohort utilized services in 2018, compared to 60% for the SMI cohort and 30% for the IDD cohort. The SMI cohort utilized services significantly more for mood and anxiety disorders, whereas the IDD cohort utilized services significantly more for comorbid neurodevelopmental conditions, anxiety, and trauma-related disorders. People with IDD demonstrated substantially lower rates of telehealth utilization, while people in the cohort with IDD and SMI demonstrated similar or higher rates of telehealth utilization compared to people with SMI only in adults.

The COVID-19 pandemic appeared to partially disrupt utilization across all cohorts and age groups. The authors note that little is known about challenges during the widespread expansion of telehealth mental health services during the COVID-19 pandemic. Findings suggest that people with IDD and SMI experience trauma- and stressor-related disorders that require treatment at younger ages than people with SMI only. Observational claims data do not support causal inferences regarding telehealth efficacy without direct clinical outcome data.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Few populations face more disadvantage than those with lifelong intellectual and developmental disabilities (IDD) and those with serious mental illness (SMI). People with IDD may face unique challenges in the manifestation and treatment of SMI; little is known about these challenges during the widespread expansion of telehealth mental health services during the COVID-19 pandemic which disrupted service availability. Using Medicaid claims from Kansas, Massachusetts, New York and South Carolina, mental health service utilization patterns for three cohorts of people ages 1–45 years were studied: those with IDD, those with SMI, and those with SMI and IDD. Utilization was examined before (2018–2019) and during (2020–2021) the emergence of telehealth services for each cohort. Meta-analysis was used to compare odds of mental health service utilization by demographic subgroups. The prevalence of mental health service utilization was approximately 75% for the IDD/SMI cohort, 60% for the SMI cohort, and 30% of the IDD cohort in 2018. Teens 13–17 years and young adults tended to have the highest levels of service utilization. Service utilization was driven by different diagnoses for the groups. The SMI cohort utilized services significantly more for mood and anxiety disorders, and the IDD cohort utilized services significantly more for comorbid neurodevelopmental conditions, anxiety, and trauma-related disorders. The IDD/SMI cohort utilized services more bipolar and related disorders and had a younger median age of service utilizers for trauma- and stress-related disorders than the SMI cohort. The IDD/SMI cohort had the highest mental health service utilization rates compared to the other two cohorts, with minimal urban-rural differences, suggesting mental health services may be reaching those at the highest levels of risk for adverse outcomes. People with IDD demonstrated substantially lower rates of telehealth utilization for mental health needs; however, people in the cohort with IDD and SMI demonstrated similar or higher rates (in adults) of telehealth utilization compared to people with SMI only. Even with expanded telehealth services, the COVID-19 pandemic appeared to partially disrupt utilization across all cohorts and age groups. Findings suggest that people with IDD and SMI experience trauma- and stressor-related disorders that require treatment at younger ages than people with SMI only.