Since the onset of the pandemic, teletherapy has skyrocketed as a convenient alternative to traditional, in-person mental health services. However, as we explored in Episode 44 of the Sit and Stay Podcast, a recent article by Ellen Barry in The New York Times (published January 15, 2025) titled “Online Therapy Boom Has Mainly Benefited Privileged Groups, Studies Find” uncovers how this surge in virtual counseling primarily benefits wealthier, more educated individuals—leaving behind low-income families and underserved communities who arguably need help the most.

In this blog post, we’ll examine the factors driving this divide, discuss how mental health professionals can address key barriers, and share a real-world anecdote that highlights the system’s ongoing challenges.

The Promise vs. Reality of Telehealth for Mental Health

Originally, telehealth was touted as a game-changer for regions with limited access to healthcare, particularly rural and economically disadvantaged areas. In practice, while teletherapy has allowed many clients to stay connected with providers (especially during pandemic shutdowns), it hasn’t significantly broadened coverage for those in critical need. Several market forces and systemic policies have pushed clinicians to prioritize higher-paying private or well-insured patients, thereby unintentionally widening disparities.

Key Observations

Who Benefits Most: Higher-income individuals with robust insurance or the ability to pay out of pocket.
Persistent Barriers: Limited broadband in rural areas, lack of private spaces at home, and digital literacy gaps.
Economic Incentives: Private telehealth platforms often pay clinicians more, diverting them from community-based clinics that serve low-income populations.

Why Online Therapy Falls Short for Underserved Populations

Several issues have prevented teletherapy from effectively reaching marginalized groups:

1. Insurance Complexities

Inconsistent reimbursement rates and administrative hurdles make it difficult for smaller clinics to offer virtual care, especially in states where insurers demand physical office addresses.

2. Market Forces

With high demand for mental health services, clinicians are often pulled toward better-paying private telehealth platforms, reducing provider availability in low-income regions.

3. Broadband and Privacy Concerns

Although smartphones have become more common, stable internet connections and private, quiet spaces for therapy sessions remain major obstacles for many families.

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Together, these factors show that telehealth’s main hurdles go beyond technology—it’s economics and policy that truly shape who can access online therapy.

How Mental Health Providers Can Expand Teletherapy Access

Despite the challenges, there are tangible steps that mental health providers and telehealth platforms can take:

Streamlined Credentialing & Better Reimbursement: By simplifying the process and improving rates, more providers will be incentivized to treat lower-income patients.

Targeted Outreach: Placing telehealth hubs in schools, community centers, or through social service agencies can help families who might not otherwise seek care.
Flexible Scheduling & Reminders: Evening or weekend options, plus text-based reminders, can accommodate working caregivers and ensure appointments don’t get missed.
Partnerships With Existing Programs: Integrating telehealth into community-based clinics that already serve at-risk populations can reduce no-shows and break down transportation barriers.

Improving Black Youth Mental Health Services

Research cited in Ellen Barry’s article underscores a severe drop in mental health service usage among Black youth during the pandemic. Economic strain, single-caregiver households, and skepticism toward new technologies all play a role. To counter this trend, strategies might include:

School-Based Telehealth: Bringing sessions directly to where children spend most of their day.
Provision of Devices and Hotspots: Ensuring families have the hardware and data plans necessary for uninterrupted care.
Culturally Competent Outreach: Encouraging training and recruitment of Black mental health professionals and community liaisons to improve trust and engagement.

The Impact of High-Paying Telehealth Platforms on Community Care

Telehealth platforms offering attractive compensation can siphon providers away from underserved communities. Higher pay and simpler administrative processes may help a therapist build financial stability but can erode local clinical resources. Balancing fair compensation with community-oriented work is crucial; collaboration among insurers, policymakers, and telehealth providers is needed to create more equitable reimbursement systems.

The Mental Health Business Moment of the Week

In this week’s business moment, a real-world example illustrates the systemic hurdles that can limit telehealth’s potential. A practitioner, hoping to serve families in Hawaii via telehealth, was fully licensed in the state but learned that an insurer required a physical Hawaii address to grant in-network status.

This policy effectively excludes out-of-state clinicians who might otherwise help fill service gaps in rural or underserved Hawaiian communities. It’s a reminder that insurance and regulatory frameworks often lag behind technological capabilities, creating unnecessary barriers even when providers are willing to help.

Teletherapy’s Future: Can It Become More Equitable?

Teletherapy itself still holds promise, but merely having the technology in place won’t solve deeper economic and systemic issues. Alongside telehealth, exploring complementary models—like single-session interventions, community-based programs, and integrated services in schools—may ensure more people receive timely, effective care. Ultimately, a blended approach that combines virtual sessions with on-the-ground support could strike the right balance.

While teletherapy has made mental health services more convenient for many, it hasn’t yet delivered equitable access across income levels, racial groups, and geographic locations. Addressing these imbalances requires cooperation among policymakers, insurers, clinicians, and community organizations.

By embracing new funding models, proactively targeting underserved areas, and innovating beyond the standard weekly therapy format, mental health professionals can steer telehealth closer to its original promise: improving care for everyone, not just those who already have the means to afford it.

Have a question or topic you’d like us to explore? Contact us at sitandstay@ripsytech.com.

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Is the Teletherapy Boom Failing Those Who Need It Most?