Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study (Preprint)

Abstract

BACKGROUND The COVID-19 pandemic resulted in the rapid adoption of telehealth services to provide mental health care from a distance. Despite research suggesting the value of telehealth, once pandemic-related restrictions eased, some jurisdictions reduced telehealth provision while others continued. There is a dearth of knowledge around enabling and facilitating factors that support the continued use of telehealth in mental health services. OBJECTIVE This study explores factors associated with the uptake and retreat from telehealth across a multi-regional outpatient mental health service in Aotearoa New Zealand. We aim to contribute to understanding factors influencing clinicians’ use of telehealth services to inform policy and practice. METHODS Applying an interpretive description methodology, this mixed methods study involved semi-structured interviews with 33 mental health clinicians and a time series analysis of population-level quantitative data laying out clinician appointment activities prior to and throughout the COVID-19 pandemic. Interviews were thematically analysed, and hypotheses drawn from these interviews were tested against activity data. RESULTS Predisposing factors for telehealth use included familiarity with audiovisual services and experiences of telehealth training, specific specialist role considerations, and client and clinician demographic factors. Permissive factors that influenced the decision to conduct an appointment by telehealth included the technical useability of telehealth tools by clients and clinicians, changes to service accessibility, digital exclusion, and offering telehealth options to improve client choice. CONCLUSIONS For telehealth services to thrive when they are not required by circumstances such as pandemic, there are needs to invest in in telehealth training for clinicians, digital infrastructure, and resources for mental health teams.