Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review

Abstract

Background The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. Objective We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. Methods We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country’s COVID-19 Stringency Index, which reflects the stringency of a government’s response to COVID-19 restrictions at a specific time. Results Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries’ face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. Conclusions During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients’ preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users.

Evaluation of Implementation Strategies for Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-Based Stress Reduction (MBSR): a Systematic Review

“…[41][42][43][44][45] While the COVID-19 pandemic has rapidly expanded telehealth and asynchronous options for mental health care, additional work is needed to establish effectiveness, implementation outcomes, and equitable Reach and Adoption for specific therapies and conditions. [41][42][43][44][45][46][47][48] Similarly, modified brief therapy protocols for providing CBT in primary care may increase patient access and use, but need additional evaluations to establish effects. 35,[49][50][51] It will be important to distinguish the "core" of essential treatment characteristics from the "adaptable periphery" of elements that may be modified without threatening effectiveness.…”

Telemedicine, Telepsychiatry and COVID-19 Pandemic: Future Prospects for Global Health

“…Certainly, a risk exists that telemedicine may be considered an equal substitute for face-to-face healthcare services, and could even be incentivized mostly as a means to cut down on expenses and costs or as an ill-advised form of incentive enabling physicians to earn more through over-service, which may come to the detriment of patient care. In this regard, it will be necessary to improve safety with the use, training, and experience of digital devices in all modes for both doctors and service users [ 64 , 65 ], but also to raise awareness as to the true purposes and fundamental goals of telemedicine, i.e., to improve accessibility without compromising care. To that end, the development of broadly shared ethical standards, in the form of best practices and guidelines, national legislative initiatives, and the international sharing of information and data on all aspects and complexities related to telemedicine practices need to be encouraged, for the ultimate purpose of optimizing and harmonizing telemedicine-based care for the sake of all patients.…”

Impact of COVID-19 on Neuropsychiatric Disorders

“…Important steps and innovations have been taken over the last 2 years to enable better service delivery to the affected populations. For instance, use of telemedicine and electronic prescriptions have become pivotal tools to be implemented globally [ 93 ]. This could be an essential element of continuity of care, especially during the lockdown or quarantine period.…”