Broadband Expansion's Impact on Access to Mental Health Care In Rural Illinois

Background/Purpose: Rural Americans are disproportionately impacted by mental health provider shortages. Distance to care, transportation costs, lack of providers, and heightened levels of perceived stigma are significant barriers to mental health care in rural areas. Expectations within the mental health field suggest telehealth services can increase access to care and meaningfully address the longstanding provider shortage in these areas.. Lack of high-speed internet infrastructure presents a significant barrier for this solution. The expansion of broadband internet infrastructure in rural areas is expected to help ameliorate the service gap. Despite an overwhelming expectation within the literature, no evidence has yet been generated to determine whether these broadband expansions in rural areas result in meaningfully increased access to mental health care. This study uses mental health visit data from the Midwest Electronic Health Record to evaluate changes in rates of access from 2017-2025 between Illinois counties that received broadband internet expansion and demographically matched comparison counties. Together with an ongoing multi-state evaluation, this study provides initial results on the impact of internet expansion projects on rural access to mental health care.

Methods:
Data and samples: Counties that received broadband expansion grants (n=6) were identified through the Federal Communications Commission. Comparison counties (n=6) were chosen for demographic similarity on rurality, median age, median income, poverty rate, and Medicare insurance rate using American Community Survey 5-Year Estimates. Mental health appointment data is drawn from the Midwestern Electronic Health Record, collected at the patient level from all SSM Health providers throughout the state. Each year’s sample includes 115-170,000 visits.

Measures: Visit data is used to generate discrete counts of mental health utilization per county, per year. Eligible visits are those made within the 2017-2025 time period by a patient in a rural Illinois county which included a mental or behavioral health code in the ICD-10 or Current Procedural Terminology (CPT) code data for the visit. Discrete counts for various visit types per county including total visits, in-person, telehealth, adult/minor, and diagnostic grouping (anxiety, depression, substance use disorder, etc) are provided for each county and year. Within-county and between-county comparisons are made for 3 time periods: baseline (2017-2019), midpoint (2020-2021), and treatment (2022-2025).

Preliminary Results: Initial analysis demonstrates mixed impacts and weak effect size. Chi square analysis on the six matched county pairs yields 2 pairings with no significant difference in telehealth adoption at any time period, 2 pairings with strong growth in telehealth adoption in the treatment group across all periods, and 2 pairings with ambiguous results due to differences at baseline (Cramer’s v <0.1 for all). Difference-in-Differences (DiD) tests reveal treated counties did not have any meaningful gains in telehealth adoption over comparison counties.

Conclusions and Implications: These findings are a subset of a larger, three-state study which will further refine analysis. However, these results suggest that broadband expansion to previously underserved rural areas may not meaningfully close the access gap. This suggests the need for more robust rural intervention plans to address mental health provider shortages and increase access to care.