Designing better mental healthcare facilities

'Telemental health' review’s interesting conclusions

A review of mental healthcare provided by phone and video call during the COVID-19 pandemic has shown that while many service-users could continue accessing some support, the shift to remote care presented ‘significant barriers' to certain groups.

Researchers involved 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’.

The study, ‘Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review’, published on 9 December, 2021 in the Journal of Medical Internet Research, reviewed 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 most service-users during the pandemic, and highlighted its value in emergency situations. Remote care’s benefits included increased convenience and accessibility for staff and patients. and reduced travel costs, while  some studies reported that more family members were able to attend family therapy or family education sessions since care was moved online.

The shift to telemental health also presented challenges, however – such as difficulties in picking up on non-verbal cues, and establishing a strong therapeutic relationship. While the studies came from a variety of higher income countries, similar challenges tended to be experienced.

Undertaken 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 at King’s College Hospital NHS Foundation Trust, and  King’s Improvement Science, funded by King’s Health Partners and Guy’s and St Thomas’ Foundation.

Fiona Gaughran, director of Research and Development at South London and Maudsley NHS Foundation Trust, and Professor of Physical Health and Clinical Therapeutics at King’s College London said: “Our Trust 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 face-to-face once restrictions on in-person contact had loosened.

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

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 worldwide had to rapidly shift from face-to-face models of care to delivering most treatments remotely. 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, and those 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.”

To read the full review, visit: https://www.jmir.org/2021/12/e31746/

 

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