Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context

Abstract

Background Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required.

Effective Modalities of Virtual Care to Deliver Mental Health and Addictions Services in Canada

“…Current documents have focused broadly on virtual care, and do not consider the specific nuances that are critical to consider for virtual mental health care (e.g., active suicidal ideation). 79 Moreover, to date, only one study 80 has focused on elucidating some of the system and organizational factors (e.g., workflow, setup support) that are relevant for facilitating and supporting virtual mental health care. With limited data on the organizational and system-level facilitators and barriers to delivering virtual mental health care, particularly to Black, racialized and/or marginalized populations, investing in projects that partner with racialized and underserved populations to examine system delivery of virtual care may be useful to better understand the challenges of accessing virtual mental health care at a population level.…”

The Association Between Changes in the University Educational Setting and Peer Relationships: Effects in Students' Depressive Symptoms During the COVID-19 Pandemic

“…Despite the apparent mental health detriment spanning 18 months from 2019 to 2020 and 2021, the investment in the promotion of mental health care and the development of virtual educational solutions ( 20 , 21 ), the number of students receiving treatment did not significantly increase after the beginning of the pandemic. The WHO mental health survey estimated that only 23.1% of the students with mental illness received adequate treatment ( 22 ).…”

“…Due to the expected consequences of the pandemic and its life-change implications, many countries started to promote the importance of mental health care, and virtual care has become a growing area of investment ( 20 , 21 ). Previous studies on mental health care help-seeking behaviors have established that many university students with mental health problems do not seek help ( 22 ).…”

A Longitudinal Study of the Psychological State of Teachers Before and During the COVID-19 Outbreak in Mexico

“…From the research point of view, future studies should be focused on assessing the effectiveness of mental health interventions that could be implemented under the special circumstances of the COVID-19 pandemic (e.g., social distancing measures). Exploring suitable intervention options such as remotely-delivered, self-administered, and digital interventions ( Strudwick et al, 2021 ; Gorenko et al, 2021 ; Budhwani et al, 2021 ) that could mitigate the negative effects of the pandemic on teachers’ mental health is recommended as the next step to tackle the problem that our study presented. From the policy-making point of view, the government and education system authorities should join efforts to provide self-care strategies, resources, equipment, and training to reduce the stress that teachers experience due to the challenging shift to distance learning.…”