Rural mental health service utilization in a Texas telepsychology clinic

Objective To determine if service utilization behaviors varied with the remoteness of clients served by a telepsychology clinic in a predominantly rural health professional shortage area (HPSA) in Texas. Methods Archival data from 290 low-income clients were analyzed to test associations between service utilization behaviors and clients' distance from the nearby access points where they traveled to receive counseling services from remotely located counselors. Results Distance to access points did not predict differences in service utilization behaviors. However, clients in rural counties traveled farther to receive services than clients in metropolitan areas. Some utilization behaviors varied by demographic variables and depressive symptom severity. Conclusions A "hub and spoke" model of telehealth service delivery is an acceptable model for improving access to mental health care services in rural and underserved communities, even for clients who live relatively far from access points. Telehealth providers should consider geographic, socioeconomic, transportation, and health-related barriers to care experienced by clients when implementing services and policies.