Examining the state of telehealth for mental health and substance use care after the coronavirus disease 2019 pandemic: An integrative review

Abstract

Objective

The objective of this integrative review was to synthesize literature and provide implications for clinical practice on telehealth use among patients with serious mental illness and substance use disorders following the coronavirus disease 2019 pandemic.

Methods

An integrative review guided by Socio-Technical Systems Theory was applied. The PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Academic Search Complete, and Gale Health and Wellness databases were searched for publications from 1 January 2019 to 1 December 2024. Articles selected according to the established inclusion and exclusion criteria were evaluated using a rapid critical appraisal checklist developed by Fineout-Overholt and Melnyk.

Results

Among the 172 articles reviewed, 16 peer-reviewed and 2 government publications were included. Four themes were identified: (a) treatment adherence; (b) satisfaction reported by patients and providers; (c) telehealth policy developments; and (d) access to services. Telehealth supported continuity of care, improved satisfaction, and improved access. Technological and financial barriers restricted equitable access. Policy changes enabled broader adoption; however, regulatory approaches varied across jurisdictions.

Conclusion

Telehealth remains an integral method for delivering mental health and substance use care following the coronavirus disease 2019 pandemic. Greater focus is needed on long-term effectiveness and limitations of telehealth.

Keywords

Telehealth coronavirus disease 2019 health care outcomes serious mental illness substance use disorders integrative review socio-technical clinical practice

Introduction

The coronavirus disease 2019 (COVID-19) pandemic fundamentally transformed the delivery of healthcare services, especially in mental health and substance use treatment. When in-person services were disrupted by public health restrictions, telehealth rapidly became the primary modality for mental health and substance use treatment.^1,2 The shift from in-person to virtual care models was particularly evident in mental health care as telehealth offered continuity amid social distancing measures. Even after the easing of restrictions, telehealth utilization remains elevated, with >80% of clinicians continuing to provide remote care.²

For patients with serious mental illness and co-occurring substance use disorders, telehealth offers both opportunities and challenges as it has improved access to consistent and coordinated care by reducing barriers that have long hindered this population's ability to engage in care such as transportation difficulties, provider shortages, stigma, and long wait times.^3–5 Patients and families have reported high levels of satisfaction with telehealth citing convenience, privacy, and reduced exposure to stigma as key benefits.⁶

At the same time, the rapid expansion of telehealth during the pandemic has also magnified inequities. Patients with limited internet access, unstable housing, or low digital literacy have often been excluded from the benefits of remote care.^7,8 Variability in reimbursement policies, state licensure regulations, and organizational readiness has created uneven access to services, exacerbating digital divides and regulatory inconsistencies across states.^9,10 These systemic disparities disproportionately affect vulnerable populations, including rural residents, racial and ethnic minorities, and patients with lower socioeconomic status.

Aims and objectives

Given these dynamics, there is a pressing need to synthesize the evidence regarding the use of telehealth for delivering mental health and substance use treatment to patients with serious mental illnesses and co-occurring substance use disorders during the post-pandemic period. By applying Socio-Technical Systems Theory (STST) as a guiding framework, this integrative review aimed to examine telehealth as a technological tool as well as socially embedded intervention. This approach provides a structured framework for distinguishing how telehealth interventions function differently across serious mental health and substance use disorder populations, which may have distinct clinical needs, engagement patterns, and risk profiles.

The purpose of this review was to synthesize findings from recent publications on telehealth use for serious mental illness and co-occurring substance use disorder care following the COVID-19 pandemic with a focus on the implications for clinical education, practice, and policy.

The specific objectives were as follows:

Identify current evidence on telehealth use for mental health and substance use treatment among patients with serious mental illness and co-occurring substance use disorders after the COVID-19 pandemic.

Examine the social and technical factors that influence the success or failure of telehealth implementation across different settings.

Synthesize the role of clinicians in shaping, delivering, and sustaining telehealth interventions for this population.

Generate recommendations to guide future clinical education, practice innovation, and policy development for providing telehealth care.

Methods

Design

An integrative review design was used for a comprehensive understanding of the use of telehealth in mental health and substance use care for patients with serious mental illness and co-occurring substance use disorders. The review was conceptually guided by the STST adapted from the foundational framework developed by Trist.¹¹ Given the complexity of modern-day systems, the STST provided a relevant perspective to examine telehealth as an integrated dynamic system. This framework informed the development of the search strategy and supported a systematic approach to selecting, analyzing, and interpreting the literature. Furthermore, it emphasized that telehealth systems emerge from the interaction of four key components: (a) technology; (b) people; (c) organizational structures; and (d) the broader external environment.

Technical subsystem (technology). The tools, techniques, procedures, devices used to accomplish work.

Social subsystem (people). The human actors, their roles, skills, relationships, values, and culture with an emphasizes that the social subsystem is not just an extension of the technical but has its own dynamics.

Primary work system/whole organization level (organization). The internal structure, formal/informal systems, group units, coordination, and management of the organization.

Macrosocial systems and the environment/causal texture (environment). The environmental variability, causal texture of the environment, or context in which organizations exist and change (regulatory/social/cultural/economic).

Review methods

A systematic approach was employed, involving a literature search of key terms and articles that met the established inclusion/exclusion criteria. Search terms were strategically combined to capture relevant studies and included keywords such as “telehealth,” “telemedicine,” “virtual care,” “serious mental illness,” “substance use disorder,” and “COVID-19.” Studies were included if they focused on telehealth, telemedicine, or teletherapy and involved patients with serious mental illness and/or co-occurring substance use disorders as determined during the screening process. Articles published prior to the COVID-19 pandemic were excluded from this review. Telephone-only interventions were also excluded as federal regulations impose specific requirements on such services and their applicability varies across federal programs and private insurers.¹² Search strategies (Appendix A) were adapted for each database using controlled vocabulary and indexing terms, while preserving the core concepts of telehealth, serious mental illness, substance use disorders, and COVID-19.

Additionally, studies involving pediatric populations were excluded due to complexities arising from proxy access through parents or guardians which fall outside the scope of this review. According to the inclusion criteria, peer-reviewed articles and government documents published between 1 January 2019 and 1 December 2024 that addressed telehealth use in mental health and substance use treatment were selected. Data from the early pandemic period were incorporated to contextualize the evolution of telehealth practices over time, thereby facilitating an understanding of post-pandemic trends. This approach also enabled the distinction between temporary emergency measures and practices that have been sustained or adapted in the post-pandemic phase. Moreover, numerous policy reforms introduced during the pandemic such as licensure waivers and modifications to reimbursement policies may exert enduring implications.^13,14 A review of the literature from the early pandemic period allowed the examination of the development of these policy and infrastructure changes. Exclusion criteria included non-English publications, commentaries lacking original empirical data, and studies outside the specified date range.

Data sources

The literature search was performed across six electronic databases, including the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Medline, Academic Search Complete, and Gale Health and Wellness. The search spanned from January 2019 (when telehealth adoption sharply increased) through December 2024, which assisted in capturing both pandemic and post-pandemic developments.

To ensure rigor and transparency in the review process, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Figure 1) were followed.¹⁵ This systematic approach guided the identification, screening, eligibility assessment, and final inclusion of studies.

Figure 1.

Strategy for article selection used in the analysis.

Gray literature was identified through targeted searches of relevant governmental and professional organization websites selected a priori based on their relevance to telehealth policy, mental health service delivery, and substance use treatment. These included major international and national public health and regulatory agencies such as the World Health Organization as well as country level health authorities (United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, and Health Resources and Services Administration), along with other relevant health policy and professional organizations, as appropriate.

Searches were conducted using each website's internal search functions when available and supplemented by keywords, including “telehealth,” “telemedicine,” “mental health,” “serious mental illness,” “substance use disorder,” and “COVID-19,” for the period from January 2019 to December 2024. This process was structured but not fully systematic and was intended to supplement peer-reviewed evidence with policy and practice guidance.

For the purposes of this review, serious mental illness is defined as a group of mental health disorders that significantly impairs an individual's ability to function daily.¹⁶ Substance use disorders is defined as a chronic but treatable condition characterized by a pattern of compulsive substance use despite the use causing significant problems in an individual's life.¹⁷ Telehealth in this review is defined as the use of remote care digital communication technologies, including video-based clinical encounters, remote psychiatric or medical consultations, and structured teletherapy sessions, to deliver mental health and substance use disorder services outside of traditional in-person settings.¹⁸ This definition encompasses telemedicine and teletherapy as modalities within the broader telehealth construct.

Search outcomes

Among the 172 articles screened, 18 fulfilled the inclusion criteria (16 peer-reviewed articles and 2 government reports).

Quality appraisal

Each eligible publication was critically appraised using standardized criteria, including methodological rigor, clarity of outcome measures, sample representativeness, and transparency of limitations. Government reports were assessed for credibility based on the issuing agency, methodological transparency, and relevance. All included studies and documents were evaluated using the Rapid Critical Appraisal Checklist developed by Fineout-Overholt and Melnyk.¹⁹ This tool assesses clarity of the research question, appropriateness of the methodology, validity of the results, and applicability to practice. Each article was scored on the following criteria: (a) study purpose clarity and relevance; (b) appropriateness of the study design in reference to the research question; (c) sample size and selection method; (d) control of confounding variables; (e) reliability and validity of measures, (f) statistical significance and precision; (g) consistency between results and conclusions; and (h) applicability to practice settings.

Among the 18 studies that were critically appraised, retrospective cohort and large claims-based studies scored highest as they demonstrated strong methodological rigor, adequate sample representativeness, robust statistical analyses, and direct applicability to practice.^20–23 Moderate-quality observational and pre–post studies^24–31 provided valuable evidence of telehealth feasibility and effectiveness although they were limited by smaller sample sizes, less control of confounding factors, and narrower generalizability. Lower-level qualitative, cross-sectional, and survey-based studies contributed important perspectives on acceptability, feasibility, and barriers, but generally scored lower on methodological rigor and sample representativeness.^32–37 Government reports were rated as credible, given their issuing agency and methodological transparency; however, they were descriptive rather than analytical.^33–34

Data abstraction

Key data elements were extracted from the 16 included studies and 2 government documents, including study design and methodology, sample characteristics, clinical or community setting, telehealth modality (video or hybrid), and a broad range of reported outcomes related to clinical effectiveness, service utilization, patient and provider experiences, and system-level factors (Appendix B). These elements were selected to capture the multifaceted nature of telehealth implementation for patients with serious mental illness and substance use disorders, particularly in the context of regulatory changes related to COVID-19. Data extraction and appraisal were conducted by a single reviewer. A second reviewer was available for consultation in cases of uncertainty or eligibility ambiguity and any disagreements regarding inclusion were resolved through discussion and consensus.

Following extraction, an iterative thematic analysis was conducted using a constant-comparison approach informed by the STST. Data were first open coded across studies without predetermined categories and then grouped based on conceptual similarity. Codes were subsequently organized into the four theoretical framework domains: (a) technology; (b) people; (c) organization; and (d) environment.

To enhance analytic clarity, findings were further stratified by the diagnostic focus of serious mental illness, substance use disorder, and co-occurring populations, allowing the identification of both shared patterns and condition-specific differences in telehealth utilization and outcomes. Through this iterative process, four overarching themes emerged: (a) treatment adherence; (b) satisfaction; (c) policy; and (4) access and disparities.

Synthesis

The synthesis of the 18 publications was guided by the application of the STST that conceptualizes telehealth not merely as a technological solution, but as a multifaceted socio-organizational intervention. As illustrated in Figure 2, the STST framework emphasizes the dynamic interplay among four key domains, as previously described.

Figure 2.

Conceptual framework applying STST to telehealth.

This lens underscores why a telehealth intervention that succeeds in one clinical context may fail in another if there is a misalignment between the technical solution and social system in which it is embedded.³⁸

Themes

The results of the integrative review emerged four key themes: (a) treatment adherence; (b) satisfaction; (c) policy; and (d) access and disparities which can be understood through the STST framework. Within the technology component, the features, reliability, and security of telehealth platforms played fundamental roles in supporting or hindering care delivery, directly impacting treatment adherence by enabling consistent patient engagement and influencing satisfaction through usability and privacy considerations. Technological limitations also contributed to disparities in access, particularly among populations with limited broadband or device availability. The people component emphasized the skills, attitudes, and engagement of both patients and providers, especially given the complexities of managing serious mental illness and substance use disorders. Patients’ motivation and digital literacy along with their’ acceptance and support were important for sustaining adherence and shaping satisfaction with telehealth.

With respect to the organization component, clinic workflows, provider training, and institutional support played vital roles in integrating telehealth into routine practice, facilitating adherence, influencing provider satisfaction, and operationalizing policy changes such as billing and compliance protocols. Finally, the environment encompassed broader regulatory, reimbursement, and policy structures that not only enabled telehealth expansion during the COVID-19 pandemic but also introduced challenges due to inconsistencies across jurisdictions. Environmental factors such as socioeconomic status and infrastructure further shaped access and highlighted persistent inequities. Overall, this socio-technical approach demonstrates that successful telehealth delivery depends on alignment between technology, people, organizational processes, and the broader environmental factors.

Across diverse systems and diagnoses, telehealth for patients with serious mental illness and substance use disorders are consistently associated with maintained or improved engagement, continuity of care, medication adherence, and reduced rates of acute care utilization, with outcomes comparable with or better than those with in-person care when implemented through hybrid or clinically appropriate models after the COVID-19 pandemic. For example, in New Hampshire, Medicaid beneficiaries with serious mental illness (n = 16,030) had minimal treatment disruption with only a 4.9% increase in interruptions compared with the previous ear, indicating strong continuity during system stress. Furthermore, younger women aged 18–34 years with post-traumatic stress disorder, anxiety disorders, or major depressive disorder were less likely to be low telehealth users.²⁴

In New York, for Medicaid beneficiaries with serious mental illness (n = 116,497), outpatient engagement improved after the COVID-19 pandemic, particularly among younger adults, suggesting that telehealth care better aligns with patient preferences and logistical needs.²⁰ Among patients experiencing their first episode of psychosis in New Orleans from 2019 to 2022, engagement peaked during periods of telehealth availability. Additionally, telehealth use was associated with a lower risk of hospitalization, demonstrating effectiveness in early, high acuity illness stages.²⁵ Similarly, telehealth outpatient programs serving patients with substance use disorders or comorbid mental health conditions (n = 4724) achieved approximately 80% engagement at 30 days, with 91% of participants attaining 30 days of abstinence and 45% requiring no further intensive outpatient care which are outcomes that are comparable to in-person programs.²⁶

Multiple studies have also reported reductions in psychiatric hospitalizations and emergency department use associated with telehealth adoption after the COVID-19 pandemic. Among Veterans Affairs patients with serious mental illness, increased telehealth use was associated with a 13% reduction in psychiatric hospitalizations (adjusted incidence rate ratio (IRR): 0.87, 95% confidence interval (CI): 0.81–0.93) and a 10% reduction in psychiatric emergency department visits (adjusted IRR: 0.90, 95% CI: 0.85–0.96) with improved outpatient visit continuity and medication adherence.²⁷ The Assertive Community Treatment teams in the Bronx that treated patients with serious mental illness (n = 68) rapidly adapted telehealth workflows while maintaining total visit volume and observed a significant reduction in psychiatric hospitalizations from 189 to 129 following telehealth integration (p = 0.026).²⁹

Medicare claims analyses also found consistent associations between telehealth use and lower acute care utilization, with telehealth users demonstrating fewer mental health hospitalizations and emergency department visits compared with those receiving only in-person care; the analyses also demonstrated higher medication adherence among telehealth users.^22,23 In substance use populations, telehealth was not associated with increased adverse events, and the initiation of buprenorphine via telehealth case among Medicaid beneficiaries with opioid use disorder and comorbid mental health conditions in Kentucky and Ohio (n > 90,000 combined) was associated with higher 90-day treatment retention with no increased risk of nonfatal overdose.²¹ Additionally, a multisite U.S. cohort reported that telehealth use in the post-pandemic era was associated with lower hospitalization rates among patients with serious mental illness, longer medication supply durations, higher treatment retention, and no increase in overdoses or crisis events.³¹

Evidence also strongly supports the positive influence of telehealth care on medication continuity, particularly for high-risk pharmacotherapies. For instance, telehealth adoption among Veterans Affairs and Medicare beneficiaries was associated with higher adherence to psychotropic medications and improved continuity of outpatient care.^22–23^,27 In India, observational data from patients with serious mental illness for whom clozapine was initiated (n = 227) demonstrated that hybrid models combining in-person monitoring with telepsychiatry enabled safe initiation and treatment continuation, along with maintenance of adherence, further illustrating the feasibility of telehealth use even for patients who are being administered medications that require closer surveillance.²⁸ These findings align with outcomes from substance use treatment settings where medication management via telehealth was associated with improved retention and continuity of care without compromising safety.^21,31

Equity, satisfaction, and policy relevant findings emerged across qualitative, mixed-methods, and survey-based studies. Telehealth use reduced geographic disparities in access, with Medicare beneficiaries in nonmetropolitan counties receiving similar or better quality of care compared with their urban counterparts.²² patients with serious mental illness experienced improved access to services and greater flexibility through telehealth, particularly due to reduced transportation and childcare barriers; providers reported telehealth to be feasible and acceptable despite concerns regarding confidentiality and limitations in observing nonverbal cues.³² Group-based teletherapy for adults with serious mental illness in a transitional care program (n = 76) was feasible and acceptable and achieved significant improvements in depression, anxiety, suicide risk, wish to live, and overall mental health with moderate to large effect sizes.³⁰

Internationally, patients with serious mental illness reported a high willingness to use telehealth as they valued convenience and access despite technology barriers.³⁷ Meanwhile, clinician surveys have indicated lower confidence among older adults, patients living alone or in supported housing, and those lacking smartphones or home internet connections, highlighting an ongoing digital divide and the need for establishing supportive infrastructure.³⁶ Federal analyses of Medicare beneficiaries with serious mental illness confirmed substantial increases in telehealth use for behavioral health care during the COVID-19 pandemic and emphasized that coverage flexibilities were central to sustaining access.^33–34 Although national focus groups of patients, caregivers, and clinicians have consistently endorsed hybrid models, telehealth use was preferred for stable follow-up and medication management, with in-person care reserved for higher clinical complexity or engagement needs.^33–34

Discussion

This integrative review demonstrates that telehealth remains a core component of mental health care in the post-pandemic era, which aligns with the existing evidence on patient satisfaction, continuity of care, and treatment adherence.^39–40 The STST framework helps explain variations across settings. For instance, even reliable platforms may prove inadequate in the absence of appropriate provider training, flexible workflows, and supportive reimbursement policies.

The current findings also reinforces evidence that telehealth improves continuity of care and treatment adherence in patients with serious mental illness and co-occurring substance use disorders.⁴¹ Satisfaction among patients and providers also remains consistently high, which is attributed to convenience, privacy, and reduced stigma.⁴² However, disparities continue to persist, particularly for those experiencing housing instability, limited broadband access, and/or low digital literacy.^7–8^,42

This review also highlights areas where research is lacking. Few studies have examined long-term outcomes, such as relapse rates or sustained recovery in telehealth versus in-person care.⁴³ A notable gap in the current literature is the limited direct comparison of in-person, hybrid, and fully virtual care models. Although several included in this review have incorporated telehealth or hybrid approaches, few have systematically evaluated differences in clinical outcomes, engagement, or feasibility across delivery modalities in this population. This limits our ability to determine the effectiveness of each model and suggests the need for more comparative research in this area that distinguishes outcomes across care formats rather than treating telehealth as a single intervention.

Similarly, although workforce challenges, such as provider burnout associated with the demands of electronic health records and remote care, have been noted elsewhere, especially in settings where telehealth has expanded after the COVID-19 pandemic, these issues were absent from the reviewed studies.^44,45 These gaps represent important opportunities for research focused on how telehealth affects provider well-being, job satisfaction, and workforce sustainability.

Furthermore, this review highlights how telehealth supports engagement and patient satisfaction while contributing to the ongoing expansion of access to care. It provides evidence to guide the development of telehealth strategies, clinical education, and health policies in the areas of mental health and substance use care. The findings are especially relevant to a range of stakeholders, including psychiatric nurses, therapists, counselors, addiction specialists, physicians, care coordinators, other healthcare professionals, and policymakers, all of whom will benefit from these insights when contributing to the design and delivery of telehealth services that are aimed at improving access, equity, and quality of care for patients with serious mental illness and substance use disorders.

Within this interdisciplinary context, nurses represent one of several key professional groups whose role spans clinical care, coordination, and systems level implementation. As frontline providers and frequent points of contact for patients, nurses contribute to care continuity, patient engagement, and symptom monitoring in both in-person and virtual settings.⁴⁶ In caring for patients with serious mental illness and substance use disorders, telehealth requires clinicians across medical fields to adapt their skills to virtual modalities while navigating complex and often fragmented care needs. Therefore, nurses, along with other healthcare providers, play an important role in building therapeutic rapport, monitoring symptoms, and supporting treatment adherence in a digital environment.⁴⁷

In addition to direct care, multiple disciplines, including nursing, medicine, and behavioral health are involved in shaping telehealth implementation and sustainability. Nurses, particularly advanced practice registered nurses, contribute a valuable perspective, given their involvement in both patient care and healthcare systems.⁴⁸ This positions them, along with other clinical and administrative stakeholders, to evaluate how telehealth platforms align with patient needs, organizational workflows, and regulatory frameworks. Their engagement in selecting and utilizing telehealth technologies as well as understanding legal and policy considerations supports a broader team effort to assess the effectiveness and appropriateness of telehealth interventions for patients with serious mental illness and substance use disorders.⁴⁹

To optimize patient outcomes, clinical education and professional development must include competencies in virtual communication, remote monitoring, and cultural responsiveness. In addition, clinicians from all fields of medicine must engage in advocacy at state and national levels to collectively support telehealth reimbursement, streamline licensure regulations, and bridge digital access gaps. This is especially important when serving patients with serious mental illness and substance use disorders who often experience fragmented care.

Future research should place greater emphasis on patient perspectives around privacy, autonomy, and digital self-monitoring. When designed with users in mind, telehealth platforms can enhance engagement, adherence, and self-efficacy.^50,51 Although Kearney et al. have reported that many psychiatric–mental health nurse practitioners feel well-prepared for team-based care and telehealth delivery, they have also identified persistent gaps in leadership development, institutional infrastructure, and organizational support.⁵² Addressing these gaps through stronger leadership pathways, expanded mentorship, and increased involvement of leaders in telehealth strategy can help overcome structural barriers and support equitable and effective care for patients with serious mental illness and co-occurring substance use disorders.

Limitations

This integrative review provides a comprehensive synthesis of recent literature on telehealth care use for patients with serious mental illness and co-occurring substance use disorder; however, several factors may shape the interpretation of findings. Differences in study design, sample size, and outcome measures limit our ability to draw uniform conclusions across all settings. Although the inclusion of large administrative datasets likely minimized reporting bias, smaller single-site studies and pre-post designs may have selectively emphasized significant outcomes, limiting the generalizability of these findings. Most included studies relied on retrospective analyses or feasibility designs with some small sample studies that may have been susceptible to selective outcome reporting. Data screening, eligibility assessment/appraisal, and data abstraction were also conducted by a single reviewer which may have introduced biases in coding, interpretation, and theme generation despite the use of a structure analytic framework. Although a second reviewer was available for consultation in cases of uncertainty, independent dual review was not performed.

In addition, although the post-COVID-19 era was the primary focus, some included studies were conducted during peak pandemic periods and may have reflected conditions specific to that time. These studies were retained to provide important contextual insights into the rapid expansion of telehealth and support our understanding of how emergency practices adopted during this time have transitioned into post-pandemic care models. Although the review aimed to highlight the role of clinicians in telehealth delivery, few studies have explicitly centered the perspectives of ancillary staff or patients, indicating key areas for future research. Future studies should examine longitudinal outcomes, implementation barriers, and the lived experiences of both providers and patients to inform more responsive and equitable models of telehealth care.

Relevance for practice

In the period following the COVID-19 pandemic, the use of telehealth care for treating patients with serious mental illness and substance use disorders has relied heavily on effective and coordinated clinical practice across disciplines. Within interdisciplinary care models, mental health and psychiatric expertise can play a key role, particularly because care often relies less on physical examination and more on the assessment of behavior, affect, cognition, communication patterns, and psychosocial factors. Concurrently, clinicians across disciplines can support treatment adherence, promote continuity of care, and help address access barriers through ongoing therapeutic engagement and care coordination in telehealth settings. Findings from this review inform clinical education, decision making, and policy efforts by highlighting the need for sustainable changes, including targeted telehealth training, robust organizational infrastructure such as improved clinical workflows, and advocacy for consistent reimbursement and licensure policies. These measures will help ensure that telehealth care is delivered more effectively and equitably across care settings.

Conclusion

The evidence synthesized from this integrative review indicates that telehealth continues to be an effective and valued modality for delivering mental health and substance use services after the COVID-19 pandemic. Policymakers must consider embedding the positive shifts around regulatory reform and reimbursement in lasting frameworks to sustain telehealth benefits. Findings from this integrative review provide timely insights for clinicians navigating the rapidly evolving landscape of virtual care delivery. Clinical efforts must actively target methods using which clinicians can easily navigate areas requiring targeted care, thereby ultimately improving assessment and treatment for continuity of care.

Footnotes

Acknowledgements

The author has no acknowledgements to report. The author confirms that this submission complies with the Journal of International Medical Research Guidelines and all listed authors meet the criteria for authorship.

ORCID iD

Smith-East Marie

Ethical approval

Patient consent was not required for this work, and ethical approval was not required for the nature of this work. Any data utilized in this submitted manuscript have been lawfully acquired in accordance with The Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from Their Utilization to the Convention on Biological Diversity.

Author contributions

The author conceptualized and conducted the study as well as prepared the manuscript.

Funding

This study was supported by a University of North Florida Publishing Grant that provided funding for open access publication fees and had no influence on the design, analysis, or interpretation of the findings.

Data availability statement

All data used in this integrative review are derived from publicly available peer-reviewed studies and government reports as cited within the manuscript.

Declaration of conflicting interests

The author reports there are no competing interests to declare.

Reporting method

This integrative review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, as recommended by the Enhancing the Quality and Transparency of Health Research (EQUATOR) network.

Patient and/or public contribution

This integrative review did not require patient or public involvement as it is a secondary research study that synthesized data from previously published literature. No new data were collected directly from patients or the public, and therefore, their involvement was not applicable to the design, conduct, or reporting of this review.

Appendix B

Evaluation of the use of telehealth in providing mental health and substance use services post COVID-19.

Author / year	Sample/Setting	Research design	Substance use versus mental health	Key findings
Ainslie et al., 2022²⁴	Community MH center Medicaid beneficiaries with SMI in New Hampshire, U.S. (n = 16,030)	Retrospective EHR analysis	Mental health	Telemedicine reduced treatment interruptions (only a 4.9% increase in treatment interruptions compared to year prior); female patients 18 to 34 years of age with post-traumatic stress disorder, anxiety disorder, and with major depressive disorder less likely to be in the low telemedicine utilization group
Bareis et al., 2023²⁰	Medicaid outpatient SMI population in New York (n = 116, 497)	Retrospective cohort (EHR/claims)	Mental health	Telehealth improved engagement post-pandemic especially among younger adults.
Chaudhry et al., 2023²⁵	First-episode psychosis in New Orleans, LA, U.S. 2019: (n = 173); 2020: (n = 152); 2021: (n = 226); 2022: (n = 177)	Retrospective clinic records (2019–2022)	Mental health	Engagement peaked with telehealth; telehealth linked to lower risk of hospitalization
Contreras-Schwartz et al., 2024²⁶	Telehealth IOP participants with SUD or Comorbid MH in San Francisco, CA, U.S. (n = 4724)	Retrospective cohort	Substance use & mental health	∼80% engaged at 30 days; 91% achieved 30-day abstinence; 45% needed no further IOP—telehealth IOP effective. Comparable outcomes between telehealth and in-person IOP
Cummings et al., 2024²⁷	VA SMI patients across facilities in the U.S. (n = 138)	Secondary data analysis	Mental health	Telehealth adoption associated with improved medication adherence and outpatient visit continuity; increased telehealth use correlated with a 13% reduction in psychiatric hospitalizations ((adjusted incidence rate ratio (IRR) = 0.87, 95% CI: 0.81–0.93, p < 0.001)) and 10% reduction in emergency department visits for psychiatric reasons ((adjusted IRR = 0.90, 95% CI: 0.85–0.96, p = 0.002))
Grover et al., 2022²⁸	Patients with SMI initiating clozapine in India (n = 227)	Observational	Mental health	Remote supports enabled safe clozapine initiation/continuation and maintained medication adherence (hybrid in-person and telepsychiatry consultations).
Hammerslag et al., 2023²¹	Medicaid beneficiaries with OUD in Kentucky (n = 41,266) and Ohio (n = 50,648), US with comorbid MH	Retrospective cohort	Substance use & mental health	Initiating buprenorphine via telehealth was associated with higher 90-day treatment retention compared to in-person initiation, with no increased risk of non-fatal overdose
Hood et al., 2024³²	Community mental health service providers serving SMI clients involved in the justice system in Indiana, U.S. (n = 61)	Mixed-methods (semi-structured interviews and natural experiment)	Mental health	Telehealth feasible, acceptable, and increased flexibility/service reach; service providers satisfied with telemedicine addressing client transportation and childcare barriers while increasing engagement; concerns about client confidentiality, digital literacy, and limitations to gathering non-verbal client data
HHS/ASPE, 2024³³	Medicare beneficiaries with SMI (n = 840,000) across US	Government report	Mental health	Tele-behavioral health use increased significantly during the pandemic per claims data analysis; coverage for SMI populations sustained care access.
HHS/ASPE, 2024³⁴	Focus groups of patients, caregivers, and clinicians in mental/ behavioral health across US (n = 23)	Government report	Mental health	Focus group insights on balancing modalities; Best practices: Telehealth useful for stable follow-ups; in-person for clinical need or engagement; hybrid viewed as optimal.
Motamedi et al., 2022²⁹	Community ACT teams in Bronx, NY serving SMI clients (n = 68)	Retrospective observational	Mental health	ACT teams adapted telehealth workflows for SMI and total visits remained stable; telehealth maintained outreach/contacts continuity; psychiatric hospitalizations significantly decreased (from 189 to 129 hospitalizations, p = 0.026)
Pusnik et al., 2024³⁵	SUD service centers treating patients with SMI across U.S. (n = 6)	Cross-sectional survey	Substance use	Identified changes in telehealth usage rates over time in SUD services, demonstrating shifts in modality adoption after the height of COVID-19 restrictions
Puspitasari et al., 2021³⁰	Transitional care SMI program adult patients with SMI in Rochester, MN, U.S. (n = 76)	Feasibility/pre–post	Mental health	Group-based teletherapy feasible and acceptable; significant improvements in depression (95% CI: −3.6 to −6.2; Cohen d = 0.77; p < .001), anxiety (95% CI: −3.0 to −4.9; Cohen d = 0.74; p < .001), overall suicide risk (95% CI: −0.5 to −0.1; Cohen d = 0.41; p = .02), wish to live (95% CI: 0.3 to 1.0; Cohen d = 0.39; p < .001), wish to die (95% CI: −0.2 to −1.4; Cohen d = 0.52; p = .01), and overall mental health (95% CI: 1.5 to 4.5; Cohen d = 0.39; p < .001) from admission to discharge.
Qeadan et al., 2025³¹	Patients with SUD across U.S. health systems (n = 141)	Retrospective cohort (pre- vs. post-COVID 19)	Substance use	Telehealth associated with lower hospitalization for SMI subgroup, longer medication supply, no rise in overdoses or crises, and higher retention.
Robinson et al., 2023³⁶	Community public mental health SMI patients (n = 44) and their clinicians (n = 52) in Australia	Cross-sectional survey	Mental health	Clinician concerns about assessing risk and providing therapy though telephone telehealth, felt more positively using video telehealth; older patients, those who lived alone or in supported accommodation, or did not have access to a smartphone or home internet were less confident in use of video telehealth.
Wang et al., 2022²²	Medicare beneficiaries with SMI in U.S. (n = 139,138)	Retrospective cross-sectional claims	Mental health	Telemedicine in nonmetropolitan counties similar or better quality of care; patients using telemedicine had higher mediation adherence compared to those receiving only in-person care with lower rates of mental health hospitalizations; telemedicine helped reduce geographic disparities in access to care.
Wilcock et al., 2023²³	Medicare enrollees with SMI in the U.S. (n = 153,348)	Retrospective cohort	Mental health	Fee-for-service claims data revealed higher telemedicine use was associated with better medication adherence and fewer mental health hospitalizations, lower rates of emergency department visits for mental health conditions
Zhang et al., 2023³⁷	Psychiatric/general hospitals & CMHC SMI in China (n = 447)	Cross-sectional patient survey	Mental health	High willingness to use of online digital interventions such as telemedicine (acceptability), valued for convenience/access but technology barriers

ACT: assertive community team; MH: mental health; EHR: electronic health record; CMHC: community mental health center; IOP: intensive outpatient program; HHS: US Department of Health and Human Services; ASPE: Office of the Assistant Secretary for Planning and Evaluation.

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