Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation (Preprint)

Abstract

BACKGROUND Globally, the needs of those with mental health illness were particularly acute during the COVID-19 pandemic, and pre-existing disparities in health care were also highlighted. However, guidelines specifically for mental health were often limited or difficult to find, particularly in the early phases. During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab developed open access online summaries of mental health guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, vaccine hesitancy and prioritisation, to inform timely clinical decision-making. The current study aimed to examine the practice of developing evidence-based health guidelines during a health emergency in general and by using the example of the OxPPL guidance in particular. OBJECTIVE An international network of clinical sites and colleagues (in Australia, New Zealand and the UK) including clinicians, researchers and experts by experience aimed to (i) review the literature for evidence-based summaries of COVID-19 guidelines in mental health, (ii) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines, and (iii) produce a framework for response to future global health emergencies. METHODS We carried out a systematic review (protocol registered on OSF: https://osf.io/amsbj/) to identify published summaries/syntheses of guidelines for mental health care which were available during and after the COVID-19 pandemic. The impact and clinical utility of the OxPPL guidance were also assessed using clinicians’ feedback via an international survey and focus groups. RESULTS The systematic review identified 2543 records. Of these, two syntheses of guidelines met all inclusion criteria, but only one (the OxPPL guidance) used evidence-based methodology. In the survey, 81% of clinicians agreed/strongly agreed that the OxPPL guidance answered important clinical questions, 73% that the guidance was relevant to their service, 59% that the guidelines had/would have a positive impact on their clinical practice, 43% that they had shared or would share the guidance, 80% that the methodology could be used in future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint and visibility was crucial for clinical implementation. CONCLUSIONS The survey, focus groups and systematic review identified a clear unmet need for online evidence-based guidance in mental health during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare for the next health crisis, including addressing the training needs of clinicians, patients and carers especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates. CLINICALTRIAL N/A