Mental health professionals and telehealth in a rural setting: a cross sectional survey

Abstract

Background Telehealth usage has been promoted in all settings but has been identified as a panacea to issues of access and equity in the rural context. However, uptake and widespread integration of telehealth across all parts of the health system has been slow, with a myriad of barriers documented, including in rural settings. The crisis of the COVID-19 pandemic, saw barriers rapidly overturned with the unprecedented and exponential rise in telehealth usage. The uniqueness of the crisis forced telehealth adoption, but as the urgency stabilises, pandemic learnings must be captured, utilised, and built upon in a post-pandemic world. The aim of this study was to document staff experiences and perceptions of delivering rural psychological therapies via telehealth during the pandemic and to capture learnings for future rural telehealth delivery. Methods An online cross-sectional survey that explored mental health professional’s experiences, use, and perceptions of telehealth before and after pandemic-enforced changes to service delivery. Results Sixty-two respondents completed the questionnaire (response rate 68%). Both the delivery of telehealth via telephone and online video conferencing significantly increased during the pandemic (66% vs 98%, p < .001 for telephone and 10% vs 89%, p < 0.001 for online video). Respondents indicated that client’s access to services and attendance had improved with telehealth use but their attention and focus during sessions and non-verbal communication had been negatively affected. The challenges for older adults, people with learning and sensory disabilities, and residents in remote areas with poorer mobile/internet connectivity were identified. Despite these challenges, none of the respondents indicated a preference to return to fully face-to-face service delivery with most (86%) preferring to deliver psychological therapies fully or mostly via telehealth. Conclusions This study addresses three major gaps in knowledge: the experience of delivering local telehealth solutions to address rural mental health needs, the provision of strong rural-specific telehealth recommendations, and the dearth of rural research emanating from the United Kingdom. As the world settles into a living with COVID-19 era, the uniqueness of the rural telehealth context may be forgotten as urban myopia continues to dominate telehealth policy and uptake. It is critical that rural resourcing and digital connectivity are addressed.

Care navigation addresses issues of tele-mental health acceptability and uptake in rural and remote Australian communities

“…The review concluded "Whilst rural and remote youth may prefer to access mental health services in person rather than via telehealth, further well-designed research is needed to better understand under what circumstances this preference holds true and why" [21]. While telehealth has potential to reduce barriers and improve access to healthcare for vulnerable populations, there still remains inequity in telehealth accessibility, for example, those living in rural and remote areas generally have reduced access to reliable technological infrastructure and internet [7,26,27]. Some people may lack the requisite skills or equipment [28,29], and tele-health may be less suitable for some groups.…”

“…While telehealth has potential to reduce barriers and improve access to healthcare for vulnerable populations, there still remains inequity in telehealth accessibility, for example, those living in rural and remote areas generally have reduced access to reliable technological infrastructure and internet [ 7 , 26 , 27 ]. Some people may lack the requisite skills or equipment [ 28 , 29 ], and tele-health may be less suitable for some groups.…”

“…Some people may lack the requisite skills or equipment [ 28 , 29 ], and tele-health may be less suitable for some groups. Some people with physical or cognitive disabilities may struggle to operate digital devices, and those with vision or hearing impairments or sensory sensitivities may struggle with digital communication [ 27 , 29 , 30 ], or need to rely on caregiver facilitation within sessions. Evidence on suitability of telehealth for people with autism spectrum disorder is mixed.…”

Advances and Challenges in Intellectual Disability in Rural India: A Comprehensive Review of Recent Trends

“…Programs like the Sarva Shiksha Abhiyan (SSA) aim to promote inclusive education, though the implementation is often inconsistent in rural areas [8]. Teletherapy and mobile health (mHealth) solutions are emerging as viable alternatives to traditional therapy, providing continuous support and access to specialized services in remote locations [9,10].…”

“…Teletherapy and mobile health (mHealth) solutions have emerged as viable alternatives to traditional therapy services. These technologies can connect individuals in rural areas with specialists and provide continuous support through remote monitoring and intervention [9,10].…”