Review looks at benefits and barriers following shift to remote mental health services during pandemic

A review looking at mental health care provided by phone and video call (remote care) during the COVID-19 pandemic has shown that many service users were able to continue accessing support but that the shift to remote care presented barriers to certain groups. Researchers are calling for further examination into the effects of telemental health on groups at risk of digital exclusion and for better evidence on long-term impacts.  
Value of remote care

The study, published in the Journal of Medical Internet Research reviewed a total of 77 primary research papers from five countries. It found that implementing telemental health services – provided by video, phone call, or messaging – allowed some continued support to a majority of service users during the COVID-19 pandemic and highlighted its value in emergency situations.

The benefits of remote care included increased convenience and accessibility for staff and patients and reduced travel costs. Additionally, some studies reported that more family members were able to attend family therapy or family education sessions since care was moved online.

Challenges

However, the shift to telemental health also presented challenges, such as difficulties in picking up on non-verbal cues and establishing a strong therapeutic relationship.

Alan Simpson, Professor of Mental Health Nursing at the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London and Co-Director of the NIHR Mental Health Policy Research Unit, commented:

“Early in 2020, mental health services around the world had to rapidly shift from face-to-face models of care to delivering most treatments remotely due to the pandemic. Although this change was beneficial in many ways, it also resulted in several challenges for staff and patients.

“The study found that remote care was deemed less acceptable and presented more challenges for certain groups, including new patients, service users without a private space at home for therapy, service users with a schizophrenia diagnosis, severe anxiety or learning disabilities, children, older adults, and those from lower socio-economic backgrounds.

“As telemental health was not commonly used in most services pre-COVID, staff had to rapidly adjust to a new way of working. Service users also identified certain needs and resources to enable them to effectively transition to remote care.”

Return to face-to-face appointments?

Fiona Gaughran, Professor of Physical Health and Clinical Therapeutics at King’s College London and Director of Research and Development at South London and Maudsley NHS Foundation Trust (SLaM), said:

“In the trust our teams worked very hard to support remote working during the pandemic. Most of the studies reviewed here reported high rates of adoption of remote formats, with adoption rates falling as COVID rates decreased. Service users and clinicians largely found remote contacts satisfactory, at least in the context of the pandemic, but several studies noted that service users and clinicians wanted at least some appointments to be face-to-face once restrictions on in-person contact due to the pandemic had loosened.

“This work took place as part of a Learning Healthcare System SLaM initiated during the pandemic, working with our partners across South London to rapidly feedback learning into practice.”

Nick Sevdalis, Professor of Implementation Science and Patient Safety at King’s College London, stated:

“This review has identified a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. More research into what works for who and in what context is required. This is relevant both to future emergency adoptions of telemental health, and to debates on its future use in routine mental health care.”

The study was carried out by researchers in the Mental Health Policy Research Unit at University College London (UCL) and King’s College London (KCL). The research was also supported by South London and Maudsley NHS Foundation Trust (SLaM), the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust, and by King’s Improvement Science, which is funded by King’s Health Partners and Guy’s and St Thomas’ Foundation.

To read the full review, visit: Implementation, adoption and perceptions of telemental health during the COVID-19 pandemic: a systematic review.