did remote therapy rise during covid when in-person visits stopped?
“We did see the rise of some of this distant learning of this”
a guest, a historian of psychiatry said on Lex Fridman Podcast, 2026-09-21, at 02:47. hear it in context →
first, the part that holds
the speaker is right: once in-person visits collapsed in spring 2020, mental health care moved to remote delivery. three separate us claims datasets and a survey of therapists all show it.
what we found when we went and looked
we read three us claims analyses. in a west coast-heavy clearinghouse sample, in-person mental health visits fell by about half in april 2020, and telehealth made up 47.9% of monthly visits from march to december 2020, up from almost none before. among about 7 million commercially insured adults, telehealth mental health visits rose about tenfold (1019.3%) in the acute phase while in-person visits fell 39.5%. in medicare, telehealth went from 2.1% of outpatient mental health claims before the pandemic to 54.4% in march to december 2020. a 2020 survey of 768 us therapists found 39% used remote sessions before covid and 98% during it. if anything, "some of this" undersells how big the shift was.
assertion by assertion
| assertion | verdict | what the record says |
|---|---|---|
| during covid, remote (telehealth) delivery of mental health care increased | confirmed | medicare: telehealth went from 2.1% of outpatient mental health claims (jan 2019 to feb 2020) to 54.4% (mar to dec 2020). commercial claims: telehealth visits up about tenfold (1019.3%) versus the year before. clearinghouse sample: telehealth was 47.9% of monthly visits in mar to dec 2020, versus 2,000 to 4,000 telehealth visits in each comparison year. limitation: these claims cover all outpatient mental health visits, not therapy alone. [1][2] |
| therapists specifically moved their sessions to remote delivery | confirmed | in a survey of 768 us mental health professionals (april to may 2020), 39% had used remote sessions before covid and 98% used them during it. limitation: a self-selected, mostly private-practice sample asked to recall their earlier practice. none of the claims studies we read reports psychotherapy separately from medication management. [3] |
| the rise happened when people could not see their clinicians in person | confirmed | in-person mental health visits fell 21.9% in march 2020, 49.6% in april and 55.9% in may in the clearinghouse sample. in commercial claims they fell 39.5% in the acute phase. telehealth rose over the same months, and total volume held roughly steady (2.12 million to 2.11 million monthly average). the timing matches the speaker's account. these studies describe the shift; they do not test what caused it. [1] |
| implied magnitude: "some of this" remote delivery | undersold | remote care went from a rounding error to roughly half of all outpatient mental health visits within months (54.4% of medicare claims, 47.9% of clearinghouse visits). it was the main way care was delivered, not a side channel. [1][2] |
| context: the shift outlasted the lockdown period | confirmed | in medicare, telehealth was still 42.9% of outpatient mental health claims from january 2021 to december 2023, about twenty times the pre-pandemic 2.1%. [2] |
both directions
for the speaker: every dataset we read points the same way and shows a huge change. the clearinghouse data show in-person visits halved by april 2020, with telehealth filling the gap and total visits about flat. commercial claims show telehealth up about tenfold. medicare shows telehealth going from 2.1% to 54.4% of outpatient mental health claims. nearly every therapist in a large 2020 survey had switched to remote sessions (98%, up from 39%). the medicare data also show the change largely stuck through 2023.
against: nothing in the record contradicts the claim. the only pushback is on scale and wording. "some of this" understates a shift that briefly made remote care the main way mental health care was delivered. the claims studies count all outpatient mental health visits, including medication management, so they can't isolate therapy specifically. the transcript says "distant learning", and the claim sentence reads that as remote therapy. that reading is ours and the show's framing, not a quote about therapy.
what this cannot say
all three claims datasets are us-only and cover insured populations: medicare, self-insured employers using one benefits platform, and a clearinghouse where 43% of providers were in california, oregon or washington. none breaks out psychotherapy from other visit types. the therapist survey is a self-selected convenience sample (92% female, 81% private practice) asked to recall their pre-pandemic practice. national survey data don't fill the gap: samhsa says its 2021 nsduh estimates are not comparable with 2020 or earlier years because data collection methods changed, so they cannot show a before-and-after change. our check is limited to the us and to the sources listed. we did not check other countries or what happened after 2023.
sources, each one fetched and read
- Trends in outpatient mental health services use before and during the COVID-19 pandemic. Health Affairs, 2022;41(4):573-580. doi:10.1377/hlthaff.2021.01297 What we read there: in-person mental health encounters were reduced by half in the early months of the pandemic, with rapid recovery of service delivery attributable to telehealth uptake (accounting for 47.9 percent of average monthly encounters); prepandemic telehealth volumes ranged from 2,000 to 4,000 unique encounters; 43.0 percent of providers were in california, oregon or washington. Fetched 2026-10-17 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC9056059/
- Telehealth vs in-person outpatient mental health service use and spending among Medicare beneficiaries from 2019 to 2023. JAMA Network Open, 2026;9(1):e2552239. doi:10.1001/jamanetworkopen.2025.52239 What we read there: telehealth comprised 2.1% of outpatient mental health claims prepandemic (jan 2019 to feb 2020), 54.4% during the acute pandemic (mar to dec 2020), and 42.9% postpandemic (jan 2021 to dec 2023). Fetched 2026-10-17 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC12771218/
- Therapists make the switch to telepsychology to safely continue treating their patients during the COVID-19 pandemic. Frontiers in Virtual Reality, 2021;1:576421. doi:10.3389/frvir.2020.576421 What we read there: in a survey of 768 us mental health professionals (april 24 to may 18, 2020), 39% of respondents used telepsychology before covid-19 versus 98% during covid-19; self-selected convenience sample. Fetched 2026-10-17 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC7880047/
- SAMHSA. Key substance use and mental health indicators in the United States: results from the 2021 National Survey on Drug Use and Health, 2022 What we read there: estimates based on multimode data collection in 2021 are not comparable with estimates from 2020 or prior years; mental health services counted include virtual (telehealth) services. Fetched 2026-10-17 (HTTP 200). https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHNNR122322/2021NSDUHNNR122322.htm
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