Implementation, adoption and perceptions of telemental health during the COVID-19 pandemic: a 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 synthesised 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.

Autistic young people’s experiences of remote psychological interventions during COVID-19

“…Furthermore, in line with findings from Johnsson and Bulkeley and Li et al (2021), both clinicians and service-users identified challenges, even those who considered their experience to be positive, and their respective views were concordant overall. This pattern in findings across studies somewhat contradicts the conclusion from a recent review which concluded that telepsychiatry may not be suitable for certain individuals, including those with ASD (Appleton et al, 2021). Rather, present findings suggest that there may be some autistic individuals that benefit from remote delivery and others who do not, as indicated by the inter-YP variability perceived by both the YP themselves and clinicians.…”

Implementation strategies for telemental health: a systematic review

“…Adoption of TMH has expanded during the COVID-19 pandemic to allow services to continue to offer mental health support despite social distancing restrictions. This shift in care delivery was often conducted rapidly as part of the emergency response to the pandemic, in which services had to adapt their existing face-to-face models of treatment to include remote forms of care (2). Some benefits to delivering mental health support in this way have been identified, for example, increasing access for service users who live remotely, have difficulty travelling, or find mental health care settings stigmatising or intimidating, and greater convenience for some service users (3,4).…”

“…However, there are also some challenges associated with this approach, for example, some service users may not have access to technology, internet connectivity, or a private space to use during TMH care, whilst others have identified challenges in developing and maintaining a therapeutic relationship (5,6). A recent systematic review also identified that TMH may not be suitable for all types of therapy, for example, exposure therapy or when treating trauma (2). This review also identified challenges in delivering TMH care to certain populations, for example, children and service users with learning difficulties or severe anxiety (2).…”

“…A recent systematic review also identified that TMH may not be suitable for all types of therapy, for example, exposure therapy or when treating trauma (2). This review also identified challenges in delivering TMH care to certain populations, for example, children and service users with learning difficulties or severe anxiety (2).…”

Are remote mental healthcare interventions cost-effective? A systematic review of economic evaluations of remote mental healthcare

“…The uptake of telemental health care increased rapidly during the COVID-19 pandemic as services moved from largely face-to-face models of care due to social distancing requirements (4,5). However, a systematic review conducted during the early stages of the pandemic identified a lack of evidence on the cost-effectiveness of telemental health interventions (4).…”