Date of Award

Summer 8-20-2026

Document Type

Thesis (Master's)

Department or Program

Master of Arts in Liberal Studies

First Advisor

Peter J. Thurber

Second Advisor

David Van Wie

Third Advisor

Donald E. Pease

Abstract

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and policy factors. Multivariable modeling estimates their associations with county-level mental health outcomes, while fixed-effects panel analysis assesses whether the broader relationship between health determinants and outcomes persists over time.

The policy factor shows the strongest association with mental health outcomes (β = 0.843, p < 0.001), with an estimated effect approximately 3.6 times larger than the next-largest main effect. Policy support also appears to attenuate structural disadvantage: among counties with above-median policy support, correlations between poor mental health and both economic and geographic barriers decline by approximately 64%. The analysis further identifies three county profiles within the modeling sample: 16 geographic-dominant, 20 economic-dominant, and 25 demographic-dominant counties. Fixed-effects estimates confirm a significant longitudinal association between health determinants and mental health outcomes (β = 0.342, p < 0.001), while SAMHSA estimated that 4.73% of New York adults had SMI in 2023-2024 (95% CI, 4.06%-5.52%).

These findings provide evidence for evaluating telebehavioral health as a regulated core modality rather than a temporary emergency measure. They also identify county-specific intervention examples, including reimbursement parity, audio-only coverage under specified conditions, affordable broadband, digital-navigation support, and language-accessibility standards, that correspond to local structural barriers.

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