Abstract
OBJECTIVE: To examine site-level differences in telemental health use within the Department of Veterans Affairs (VA). Findings aim to identify barriers to telemental health use to improve access to care. STUDY SETTING AND DESIGN: 122 VA facilities were classified into three groups: sites with higher levels of in-person (n = 55), video (n = 40), and phone mental health (MH) care (n = 27). We used Pearson's chi-squared and F-tests to assess for group differences on organizational characteristics and patient population variables. DATA SOURCES AND ANALYTIC SAMPLE: This was an observational study using VA administrative data from July 2021 to October 2022; analyses were conducted from June 2024 to March 2025. PRINCIPAL FINDINGS: Sites in the video group tended to be larger, high-complexity, urban facilities that served more women, younger patients, and patients with greater broadband access. Sites in the in-person group served more patients of lower socioeconomic status and treated the highest percentage of rural patients. The phone group served the next highest percentage of rural patients, followed by the video group. CONCLUSIONS: Larger, higher-complexity sites may have stronger telehealth infrastructures, and urban areas have stronger broadband connectivity to support video visits. Smaller, rural sites may benefit from targeted support to increase video use.