Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

Abstract

ObjectivesTo explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.DesignQualitative interview study, codesigned with mental health service users and carers.MethodsWe conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.SettingNational Health Service (NHS) secondary mental health services in England between June and August 2020.ParticipantsOf 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.ResultsExperiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.ConclusionsThough remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.

Reimagining authorship guidelines to promote equity in co-produced academic collaborations

“…Relatedly, who has the right to establish who deserves to be identified as a co-author? How can early-career researchers (ECRs), minoritised researchers and patient experts (or 'experts by experience', Liberati et al, 2021) be better supported to stake a claim on authorship in the context of power imbalances and institutional hierarchies? How then can we collaboratively decide which project outputsincluding but not limited to formal academic publicationsdeserve prioritisation?…”

Exploring Patient and Staff Experiences of Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data

“…The provision of this routine feedback thus aided in addressing staff perceptions. It is possible low staff expectations for VCs somewhat explains low documented uptake of VCs in comparison to telephone calls in previous research [10,13,14]. When collecting routine feedback, critically considering the purpose is important.…”

“…For example, Doraiswamy et al reviewed 543 articles relating to telehealth (including telephone, VC and other communication methods) during COVID-19, only 12% of articles presented empirical work, with few studies conducted in the United Kingdom (UK) focussing on VC [16]. Similarly, other research has focused on a single service such as orthopaedics or mental health [4,13,14]. While Dhahri et al’s [15] research focuses on feedback across a range of outpatient services from 45 patients and 79 clinicians, this was only over a three week period.…”

“…The emerging research on remote healthcare and VC implementation seems to show some benefits. For example, VCs are seen as useful for social distancing [12], may provide quicker consultation times [4], reduce travel time for patients [14] and allow for safeguarding and risk assessment [13]. However, the research to date also shows areas of concern, such as technology limitations (impairing video/sound) [4,9,15], additional burden, lack of physical examination [9], low technology confidence and limited set-up support [4], further to impaired therapeutic interactions and reduced depth of clinical encounters [14].…”

Measuring the digital divide among people with Severe Mental Ill Health using the Essential Digital Skills framework

“…During the pandemic, this might contribute to inequalities of access to digital services, including but not limited to healthcare services, due to lack of familiarity or confidence with technology 25 . More worryingly, these inequalities might remain beyond the pandemic 26 , given that transition to digital healthcare might become a more mainstream option 20, .…”