Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review

Abstract

Background Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025

What works for whom with telemental health? A rapid realist review

“…The RRR was conducted by the NIHR Mental Health Policy Research Unit (MHPRU), a team established to deliver evidence rapidly to inform policymaking, especially by the Department of Health and Social Care in England and associated government departments and NHS policy leadership bodies. The project constitutes the final stage in a programme of work on telemental health delivery carried out to meet urgent policy need, which included an umbrella review of pre-COVID evidence [1], a qualitative investigation of service user experiences of telemental health [24], a systematic review of literature on telemental health adoption conducted during the early phase of the pandemic [2] and a systematic review on the cost-effectiveness of telemental health approaches (personal communication by Clark et al, 2022). This RRR was registered on PROSPERO (CRD42021260910).…”

“…The umbrella review by Barnett et al (2021) included systematic reviews, realist reviews, and qualitative meta-syntheses on remote working before the onset of the COVID-19 pandemic [1]. The systematic review by Appleton et al (2021) synthesised primary research on the adoption and impacts of telemental health approaches during the pandemic [2]. An updated search of the latter review was conducted on 19/05/2021. We worked with our expert reference group to identify additional peer-reviewed and grey literature.…”

“…Digitally excluded service users tend to be people who are already experiencing other forms of disadvantage and already at risk of poorer access to services and less good quality care: a switch to telemental health may thus exacerbate existing inequalities [17, 18]. Additionally, concerns have been raised around impacts of telemental health on privacy and confidentiality of clinical contacts, especially for the many service users who do not have an appropriate space and facilities for its use, as well as its appropriateness for certain purposes, such as conducting assessments or risk management [2].…”

“…Following the rapid adoption of telemental health at the start of the crisis, service planners, clinicians and service users have expressed interest in greater use of telemental health long-term [2, 19, 22, 23]. However, several challenges have been identified as arising from this widespread implementation [2, 17, 19, 24, 25].…”

“…Following the rapid adoption of telemental health at the start of the crisis, service planners, clinicians and service users have expressed interest in greater use of telemental health long-term [2, 19, 22, 23]. However, several challenges have been identified as arising from this widespread implementation [2, 17, 19, 24, 25]. These include i) reaching digitally excluded populations, who may, for example, have limited technological access and/or expertise, thus compounding existing inequalities experienced by disadvantaged groups; ii) a lack of staff competence in using telemental health devices and confidence in delivering telemental health care; iii) a lack of technological infrastructure within health services; iv) challenges in managing clinical and technological risks in remotely delivered care; v) developing and maintaining strong therapeutic relationships online, especially when the first contact is remote rather than face-to-face; vi) maintaining service user safety and privacy; and vii) delivering high quality mental health assessments without being able to see or speak to the service user face-to-face.…”