Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

OBJECTIVE: To examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening. METHODS: Observational study of outpatient MH/SUD visits January 1st-June 30th, 2018–2020 by: 1) visit diagnosis group, 2) provider type, 3) patient race/ethnicity, 4) insurance, and 5) visit method (telemedicine vs. in-person). RESULTS: Each year, January–June 52,907–73,184 patients were seen for a MH/SUD visit. While non-MH/SUD visits declined during the surge relative to 2020 pre-pandemic (−38.2%), MH/SUD visits increased (9.1%)—concentrated in primary care (35.3%) and non-Hispanic Whites (10.5%). During the surge, MH visit volume increased 11.7% while SUD decreased 12.7%. During partial reopening, while MH visits returned to 2020 pre-pandemic levels, SUD visits declined 31.1%; MH/SUD visits decreased by Hispanics (−33.0%) and non-Hispanic Blacks (−24.6%), and among Medicaid (−19.4%) and Medicare enrollees (−20.9%). Telemedicine accounted for ~5% of MH/SUD visits pre-pandemic and 83.3%–83.5% since the surge. CONCLUSIONS: MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine. Despite this, widening diagnostic and racial/ethnic disparities in MH/SUD visit volume during the surge and reopening suggest additional barriers for these vulnerable populations, and warrant continued monitoring and research.