Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers

Abstract

Introduction While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. Objective This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations. Methods An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results. Results In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation. Conclusions This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

Acceptance of E-Mental Health Services for Different Application Purposes Among Psychotherapists in Clinical Training in Germany and Switzerland: Secondary Analysis of a Cross-Sectional Survey

“…Overall, our findings correspond to other research targeting the views and experiences of psychotherapists. Among European psychotherapists having mainly positive experiences with online consultations during the COVID-19 pandemic, De Witte et al ( 43 ) reported several barriers that might hinder implementation, such as data security issues or concerns about relational aspects, for instance impersonality and fostering a therapeutic alliance. In a study by Sander et al ( 86 ), German professionals reported having little experience or knowledge about internet-delivered interventions and the most frequently anticipated barriers were too severe symptoms of patients, the feared neglect of face-to-face contacts and insufficient technical equipment.…”

“…As a starting point, van Daele et al (96) have recently formulated an association with the European Federation of Psychologists' Associations (EFPA) general guidelines for mental health workers, health services, regulatory agencies as well as developers to promote the implementation of evidencebased EMH services. The strong need for training and further education also becomes visible in a recent study by De Witte et al (43), in which participants were asked whether they received any form of training on online consultations about EMH. Results revealed that only 11% of the sample received a form of training, however, only half of these training programs were specific to EMH and lasted just <4 h in every second case.…”

“…Barriers that are perceived by psychotherapists are diverse, including insufficient information ( 21 ) concerns about the technology itself (e.g., data security and privacy), lack of clear ethical guidelines and concerns about relational aspects ( 20 , 37 , 41 , 42 ). Additionally, a comprehensive legal and regulatory framework for psychotherapists, along with reimbursement schemes, is often lacking even though awareness at the policy level is increasing ( 43 ). As health experts are often the primary source of health information or treatment recommendation ( 44 ), they supposedly have a large influence on patients' attitude formation and thus on the implementation of EMH services ( 35 ).…”

Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT)

“…We did not find RCTs that tested the hypothesis that online or blended DBT is superior or at least equally effective as standard, face-to-face DBT. At the same time, we observe a steady increase of online or blended care in clinical practice, with the coronavirus pandemic as a catalyst [ 7 , 26 , 27 ]. In the absence of sufficient evidence, we think it is advisable to return to face-to-face contact as soon as possible and to remain aware of selection bias, confirmation bias and technology optimism.…”

“…Especially the DBT skills training is evolving from a treatment mode for suicidal patients with BPD to a transdiagnostic intervention [ 9 ]. Telepsychology is increasingly being used in DBT supervision and -training for professionals [ 19 – 25 ] and in mental health care in general [ 26 , 27 ]. Arguments both in favor and against such an evolution can be made.…”