People who received most of their mental health care by video had fewer mental health hospital stays and emergency visits over the following year than people seen mainly in person or by phone, according to a study of 813,699 US veterans published in JAMA Network Open on 8 September 2026. The authors, researchers working with the Department of Veterans Affairs (VA), are careful to say the result is an association, not proof that video causes better outcomes, and that the differences they found were small.

The study matters to anyone weighing online therapy because it is one of the largest real-world comparisons of the three ways most people now see a therapist or psychiatrist: a video call, a phone call, or a room in a clinic.

What the researchers did

The team used VA administrative records for every patient who completed at least three outpatient mental health appointments between July 2021 and October 2022. Each person was put into a group according to how they received most of that care: video (343,543 people, 42.2%), in person (305,189, 37.5%) or phone (164,967, 20.3%). They then followed everyone for a year, looking at four outcomes: mental health hospitalisations, mental health emergency department visits, suicidal behaviours, and the share of booked appointments that people actually attended.

Because the groups were not alike at the start, the researchers used a statistical method called inverse probability weighted regression adjustment, which tries to compare like with like by accounting for differences such as age, diagnoses and prior use of care.

What they found

Before any adjustment, the raw numbers looked like this over the follow-up year, as reported in the paper's abstract:

  • Mental health hospitalisation: 0.9% of the video group, 2.1% of the in-person group and 1.6% of the phone group.
  • Mental health emergency visits: 1.5% video, 2.6% in person, 2.3% phone.
  • Suicidal behaviours: 1.0% video, 1.2% in person, 1.3% phone.
  • Appointments completed: 71.1% on average for video, 68.0% in person and 68.4% by phone.

After adjustment, video care was still associated with a lower expected probability of each adverse outcome than either phone or in-person care, and with appointment completion 3.6 percentage points higher than in-person care and 4.1 points higher than phone care. The adjusted differences in hospitalisation were about half a percentage point. In their conclusions the authors write that video care "was associated with improved clinical outcomes compared with receiving care via phone or in-person", and add straight away that "there is still potential confounding, and the magnitudes of the ATEs were small; therefore, results must be interpreted with caution."

Why the authors urge caution

The paper itself lists the reasons not to over-read the result. People who used video tended to be younger, better off, more urban and less unwell at the start, and the researchers note that patients who receive video care "tend to be healthier and better resourced". Statistical weighting can only correct for differences that are recorded; it cannot see differences that are not. The authors also point out that a patient who already attends a clinic in person may simply be closer to an emergency department, which could make in-person patients look worse for reasons that have nothing to do with the quality of their therapy.

The study also lumps together individual therapy, group therapy and medication management, and leaves out anyone with fewer than three visits. And it was carried out in one health system, the VA, which has its own video platform and support for patients who lack devices or connectivity, described on the VA Telehealth site. Results in a commercial subscription service could differ.

How it fits with what clinicians say

A separate qualitative study by an overlapping group of VA researchers, published in Psychological Services, interviewed 24 mental health providers and leaders at six VA medical centres. Most felt the quality of video care was comparable to in-person care. Views on phone care were split: some worried about losing non-verbal information, while others valued phone calls for reaching vulnerable veterans who might otherwise get no care. The authors concluded that providers, patients and leaders need clear information about the benefits and drawbacks of each format.

Read together, the two papers suggest that video is not a second-class option for many patients, and that being able to turn up to appointments more easily may be part of the benefit. They do not show that video is right for everyone.

What this means if you are choosing therapy

For someone comparing online therapy services, the useful takeaways are practical rather than clinical:

  • Video and phone are not the same thing. In this study, phone care did not show the same associations as video. If a service offers both, it is reasonable to ask which formats your therapist uses and whether you can choose.
  • Attendance matters. The video group kept more of its appointments. If travel, childcare or work make clinic visits hard for you, a format you will actually stick with has real value.
  • Severity matters. The video group started out less unwell on average. If your symptoms are severe, you have been in hospital recently, or you are at risk of harming yourself, talk to a GP, psychiatrist or other qualified clinician about which setting suits you, rather than relying on a study average.
  • Ask about crisis cover. Any service you use should explain what happens between sessions if you are in crisis. In the US, the 988 Suicide and Crisis Lifeline is available by call or text at 988; elsewhere, use your local emergency number.

This article reports on published research and is not medical advice. Decisions about mental health treatment are best made with a qualified clinician who knows your history.