Demand for Counseling Services Remained Steady During Pandemic Despite Telehealth Delivery, Study Shows

Jul 12, 2023


Alexandria, Va. — People seeking mental health services during the COVID-19 pandemic were not deterred by the widespread shift to telehealth services, according to research findings published in the Journal of Counseling & Development, a journal of the American Counseling Association.

Study lead author Yusen Zhai is pictured. Zhai is assistant professor of counseling and director of the community counseling clinic at the University of Alabama at Birmingham.However, some racial and ethnic minorities continued their longstanding tendency to avoid counseling services, even though they were more likely than non-Hispanic white people to struggle with mental health issues, the study showed.

“The findings lend support to policies that expand insurance coverage for telehealth counseling,” said lead author Yusen Zhai, an assistant professor of counseling and director of the community counseling clinic at the University of Alabama at Birmingham. “This is particularly relevant as we navigate the post-pandemic era and consider the future of health care delivery.”

Insurers broadened coverage for telehealth services during the first months of the pandemic as lockdowns prevented counselors from seeing clients face to face. Zhai and his colleagues wondered if consumers resisted telehealth counseling because of technology infrastructure problems or misgivings about receiving therapy over the phone or internet. The researchers examined anonymous data collected from more than 52,000 individuals from universities and colleges across the U.S. between September 2018 and June 2020. The individuals had been asked about their history and attitudes regarding mental health care and had been screened for depression, anxiety and eating disorders.

Overall, the shift to telehealth did not change individuals’ intentions to seek counseling services, the results showed. The researchers also found that racial and ethnic minorities — who experienced disproportionate hardship during the pandemic due to economic inequality, poor medical care and other injustices — were less likely to seek out counseling services but were more likely to experience mental health problems.

The findings suggest that telehealth is a viable solution for delivering counseling services, especially to clients who lack transportation or face a shortage of providers near their homes, Zhai said.

“Telehealth is a step toward eliminating barriers to mental health care and services, yet accessibility and reducing the stigma around mental health issues and services in some racial/ethnic minority communities appear to have a long way to go,” he added.

In addition to Zhai, study authors included JoLynn V. Carney and Richard J. Hazler at The Pennsylvania State University. The researchers caution that their study was limited to young adults and called for future studies to include older populations and to compare the effectiveness of in-person and telehealth services.

The article, “Policy effects of the expansion of telehealth under 1135 waivers on intentions to seek counseling services: Difference-in-difference (DiD) analysis,” is available at

NOTE TO JOURNALISTS: To schedule an interview with a member of the research team, please contact ACA at

Founded in 1952, the American Counseling Association (ACA) is a not-for-profit, professional and educational organization that is dedicated to the growth and enhancement of the counseling profession. ACA represents nearly 60,000 members and is the world’s largest association exclusively representing professional counselors in various practice settings. Driven by the belief that all people can benefit from the power of counseling, ACA’s mission is to promote the professional development of counselors, advocate for counselors, and ensure that ethical, culturally inclusive practices protect our members’ clients and all people who seek counseling services.