Objective:

To evaluate the comparative effectiveness of video, phone, and in-person mental health care among veterans.

Approach:

• Study Design: A retrospective comparative effectiveness study using VA administrative data from veterans who completed at least 3 outpatient mental health appointments between July 2021 and October 2022.
• Cohort Assignment: Participants were categorized into video, phone, or in-person cohorts based on the modality accounting for more than 50% of their outpatient mental health care.
• Outcome Measures: Primary outcome was the probability of at least 1 mental health hospitalization; secondary outcomes included mental health ED visits, suicide behaviors, and appointment completion rates.
• Statistical Analysis: Inverse probability–weighted regression adjustment (IPWRA) was used to estimate average treatment effects, accounting for various patient and facility-level covariates.

Key Findings:

• Video care was associated with lower rates of mental health hospitalization and emergency department visits compared to phone care.
• Video care showed higher appointment completion rates than both phone and in-person care.
• No significant differences were found in outcomes between video and in-person care, except for appointment completion.

Interpretation:

The findings suggest that video-based mental health services may offer advantages over telephone services, particularly in reducing hospitalization rates and improving appointment adherence. The lack of significant differences between video and in-person care outcomes indicates that video services can be a viable alternative to traditional face-to-face interactions.

Limitations:

• The study was retrospective and nonrandomized, which may introduce bias.
• Exclusion of patients with equal distribution of care modalities may limit generalizability.

Conclusion:

This study supports the effectiveness of video mental health services for veterans, highlighting their potential to enhance care delivery and outcomes. As telehealth continues to evolve, integrating video services into mental health care could improve access and engagement for veterans, while maintaining comparable efficacy to in-person care.