Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review

Abstract

Background Severe deterioration in mental health and disrupted care provision during the COVID-19 increased unmet needs for mental health. This review aimed to identify changes in mental health services for patients in response to the pandemic and understand the impact of the changes on patients and providers. Methods Following the Cochrane guidance for rapid reviews, Cochrane CENTRAL, MEDLINE, Embase and PsycInfo were searched for empirical studies that investigated models of care, services, initiatives or programmes developed/evolved for patients receiving mental health care during COVID-19, published in English and undertaken in high-income countries. Thematic analysis was conducted to describe the changes and an effect direction plot was used to show impact on outcomes. Results 33 of 6969 records identified were included reporting on patients’ experiences (n = 24), care providers’ experiences (n = 7) and mixed of both (n = 2). Changes reported included technology-based care delivery, accessibility, flexibility, remote diagnostics and evaluation, privacy, safety and operating hours of service provision. These changes had impacts on: (1) care access; (2) satisfaction with telehealth; (3) comparability of telehealth with face-to-face care; (4) treatment effectiveness; (5) continuity of care; (6) relationships between patients and care providers; (7) remote detection and diagnostics in patients; (8) privacy; (9) treatment length and (10) work-life balance. Conclusions A shift to telecommunication technologies had a significant impact on patients and care providers’ experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations.

Impact of Digital Inclusion Initiative to Facilitate Access to Mental Health Services: Service User Interview Study

“…However, while this scheme was introduced in the height of Covid, the NHS long term plan had long recommended a continued expansion of digital transformation initiatives across the UK [9]. Mounting evidence compiled before, during, and after COVID-19 suggests that online therapeutic interventions are at least equivalent to in person alternatives [7] and are increasingly being trialled and evaluated in specialist healthcare services, such as prisons [46]. Outside of the NHS, many essential public services have also moved online with the UK government committing to increased spending and investment to further improve efficiency and ease of access [47].…”

“…Disruption to community and third sector services further proved detrimental to already at-risk populations, including those with pre-existing mental health conditions and severe mental illness or those affected by financial destitution and homelessness [5,6]. As such, the integration of digital solutions into healthcare became inevitable with advocates noting greater flexibility to meet individual needs and digital transformation as key to implementing the NHS long term transformation strategy [7,8,9].…”