Teletherapy and hospitalizations in patients with serious mental illness during the COVID-19 pandemic: A retrospective multicenter study

Abstract

Background Interventions with patients with Serious Mental Illness (SMI) had to adapt rapidly to the COVID-19 safety restrictive measures, leading to the widespread use of teletherapy as an alternative. Objectives The aims of this study were to compare the use of different intervention modalities with patients with SMI during the first wave of the pandemic and examine their association with emergency hospital visits and hospitalization rates six months later. Methods Records of 270 service users of fifteen outpatient mental health services across Spain, were retrospectively assessed. We retrieved clinical data and data on the modality of intervention received (in-person, over the phone, videoconferencing) in three time points (before, during and after the first COVID-19 wave). Also, data were retrieved regarding the frequency of their emergency hospital visits and hospitalization rates, two, four and six months later. Results During the first wave of the pandemic, teletherapy (over the phone and videoconferencing) was the modality most widely used, whilst in-person therapy sessions were significantly reduced, though they seemed to return to pre-COVID levels after the first wave had passed. Importantly, patients receiving teletherapy during the first wave seemed to have significantly fewer emergency visits and hospitalization rates four and six months later (χ2 = 13.064; p < .001). Multilevel analyses revealed that patients receiving videoconferencing interventions had fewer hospitalizations six months after the first wave (OR = 0.25; p = .012). Conclusions Under challenging circumstances as those created by the COVID pandemic, teletherapy is a useful tool for protection against hospitalizations and can be used as an alternative to in-person therapy, to ensure continuity of care for patients with SMI.

Has Anything Changed in the Frequency of Emergency Department Visits and the Profile of the Adolescent Seeking Emergency Mental Care during the COVID-19 Pandemic?

“…It is also possible that although there was a larger need to seek mental health care during the initial phases of the pandemic, some countries might have established standards of telehealth psychiatric care for children and adolescents, and the telehealth services were largely sufficient and effective in fulfilling the needs of patients. In fact, Sánchez-Guarnido et al [ 83 ] reported that for patients who received teletherapy during the lockdown, ED visits and hospitalization rates were reduced four and six months after the first wave of COVID-19. Using teletherapy during stressful periods, when in-person sessions are not feasible, was a protective factor against hospitalization, particularly in the medium term [ 83 ].…”

“…In fact, Sánchez-Guarnido et al [ 83 ] reported that for patients who received teletherapy during the lockdown, ED visits and hospitalization rates were reduced four and six months after the first wave of COVID-19. Using teletherapy during stressful periods, when in-person sessions are not feasible, was a protective factor against hospitalization, particularly in the medium term [ 83 ]. Moreover, to minimize the risk of exposure of hospitalized patients to the COVID-19 infection, visits from family and friends to patients were banned or severely restricted.…”

Digitalising mental health care: Practical recommendations from the European Psychiatric Association

“…Many patients and clinicians had their first teleconsultation during the pandemic and they have quickly learned to appreciate the convenience of attending a medical appointment from the security and comfort of their home environment. Research conducted before and during the pandemic suggests that telepsychiatry improves access to professional mental health care and outcomes (e.g., reduces emergency visits and hospitalisations), resulting in high cost and time savings and life quality gains [8]. Furthermore, there is increasing evidence that telepsychiatry is a good substitution for face-to-face delivery in terms of effectiveness, care quality, treatment outcomes, and compliance for many mental health problems across a wide range of populations and settings, although long-term real-life evidence is still missing [9, 10].…”