Abstract
BackgroundEarly in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care.ObjectiveTo investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation.MethodsFour databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis.ResultsA total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified.ConclusionsImplementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these.Trial RegistrationPROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025
Highlights
Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic
Not all service users can be reached by this means, and better evidence is needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these
Since the onset of the COVID-19 pandemic in the first few months of 2020, most countries have experienced a severe disruption of mental health service delivery in its usual forms [1]
Summary
Since the onset of the COVID-19 pandemic in the first few months of 2020, most countries have experienced a severe disruption of mental health service delivery in its usual forms [1]. There is some positive health economic evidence, with several studies suggesting telemental health is no more expensive than face-to-face delivery and tends to be more cost-effective [12] This approach appears to be a viable and inexpensive treatment option where access to emergency services is limited, and associations have been found with reduced psychiatric admissions [10]. In 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic This resulted in several challenges for staff and patients, and in benefits such as convenience or increased access for people with impaired mobility or in rural areas. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care
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