Abstract
COVID-19 has placed additional challenges on mental health services. Video consultations (VCs) have provided a short-term solution to lockdown restrictions but could also increase long-term capacity to meet the anticipated rising demand. A total of 7752 VCs were conducted over six weeks. Thematic analysis of 474 online survey responses identified twenty patient attributes that influenced staffs’ decisions to offer VCs. Their opinions were diverse, at times contradictory, and not always evidence based. There was reasonable consensus (and published evidence to support) of the probable suitability of VC for patients who: are IT savvy and suitably equipped; are teenagers; live in remote/rural locations; have caring responsibilities; have anxiety disorders or express a preference. No consensus was reached regarding eight attributes and there was a corresponding paucity of evidence, indicating the need for further research. Conversely, old age; paranoia, sensory impairment/communication difficulties; high risk and trauma/PTSD (posttraumatic stress disorder) were generally seen as contraindicated by staff, despite published evidence of success elsewhere. It may be possible to overcome staff’s reticence to offer these groups VCs. As staff are effectively the gatekeepers to VC interventions, it is important to understand and support them to overcome reservations that are contrary to the empirical evidence base. This will ensure that their initial anxieties do not become unnecessary barriers to services for those most in need. As with all mental healthcare, such decisions should be made collaboratively, and on an individual basis.
Highlights
The phrase “strange and unprecedented” seems to have become ubiquitous in most discussions about healthcare during the COVID-19 global pandemic
As staff are effectively the gatekeepers to this form of treatment, their preconceptions are important as they could pose barriers to mental healthcare for certain vulnerable groups of patients at a time when they most need services [1,19], creating damaging self-fulfilling prophecies. In light of these issues, this paper reports the relevant findings from one large mental health and disability NHS trust’s video consultation (VC) project that started before, and extended into, the current COVID-19 pandemic
With reference to the literature [20], and the project brief, a bespoke set of questions was developed as an online staff survey (Table S1, supplementary material), two of which are the subject of this paper: 1. “Are there any types of service user who would be suited to online video consultations and why?”
Summary
The phrase “strange and unprecedented” seems to have become ubiquitous in most discussions about healthcare during the COVID-19 global pandemic. Mental healthcare in the United Kingdom has been under considerable strain for over a decade [1]. This pressure has increased further due to the challenges of continuing to provide care/treatment during COVID-19 lockdown restrictions [2]. In response to the long-standing cost pressures, some mental health providers have already turned to video consultations in an attempt to gain efficiencies and ‘do more with less’ [7,8]. Since COVID-19, many more providers have moved some or all of their services online [9,10,11]. Video calls in everyday life have become increasingly routine, they remain, for many patients, relatively novel and, for some, a thoroughly disconcerting experience [15,16] that could theoretically threaten the development and maintenance of therapeutic relationships with healthcare professionals
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