Remote working in mental health services: a rapid umbrella review of pre-COVID-19 literature

Abstract

Background: Tele-mental health care has been rapidly adopted to maintain services during the pandemic, and there is now substantial interest in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw not only on COVID-19 experiences, but also on the substantial research evidence accumulated prior to this. Aims: to conduct an umbrella review of systematic reviews of research literature and evidence-based guidance on remote working in mental health, including both qualitative and quantitative literature. Method: Three databases were searched between January 2010 and August 2020 for systematic reviews meeting pre-defined criteria. Reviews retrieved were independently screened and those meeting inclusion criteria were synthesised and assessed for risk of bias. Narrative synthesis was used to report findings Results: Nineteen systematic reviews met inclusion criteria. Fifteen examined clinical effectiveness, eight reported on aspects of tele-mental health implementation, ten reported on acceptability to service users and clinicians, two on cost-effectiveness and one on guidance. Most reviews were assessed as low quality. Findings suggested that video-based communication could be as effective and acceptable as face-face formats, at least in the short-term. Evidence was lacking on extent of digital exclusion and how it can be overcome, or on significant context such as children and young people and inpatient settings. Conclusions: This umbrella review suggests that tele-mental health has potential to be an effective and acceptable form of service delivery. However, we found limited evidence on impacts of large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for future tele-mental health implementation.

Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis

“…In line with previous research, participants mentioned beneficial aspects of telemental health care and innovative strategies that services adopted to address safety and technology challenges during lockdown [ 22 , 23 , 39 , 40 ]. These include improved accessibility and continuity of care, especially where difficulties such as physical mobility, social anxiety or paranoia impede travel and face-to-face contacts, increased convenience for those facing geographical barriers, convenience and communication within and between mental health teams [ 2 , 7 , 16 , 21 , 23 , 40 ]. However, participants also commented on the risk of digital exclusion of those lacking the necessary skills, resources, or privacy to engage with remote services.…”

“…An example are people experiencing significant social disadvantage or severe mental health problems including psychosis have been reported to benefit less from telemental health [ 45 ]. Evidence is lacking both on the extent of digital exclusion and on how it might be overcome [ 21 ]. Barriers to access care such as those described in Subtheme 1 .…”

“…Specific barriers to engaging with remote care identified in our interviews and previous literature were lack of familiarity with and mistrust of relevant technology, low image quality on video calls, connectivity problems, and audio delays [ 22 , 23 ]. These concerns have been shared by mental health service staff in the UK [ 7 ] and professionals have tended to report a preference for face-to-face contact for both assessment and treatment [ 21 ]. Privacy and safety have also been emphasised in the literature as serious issues to consider in telemental healthcare provision [ 21 , 24 , 47 , 48 ].…”

“…There is also positive health economic evidence, with several studies suggesting telemental health is no more expensive than face-to-face delivery and tends to be more cost-effective [ 17 ]. The use of remote consultations appears to be welcomed by many service users, who find it as satisfactory as face-to-face alternatives [ 2 , 15 , 20 , 21 ], and in some cases preferable [ 22 ], even where they have initial reservations or limited experience of using computers [ 23 ]. However, studies assessing telemental health care tend to report small-scale and carefully planned interventions with volunteer participants, rather than large-scale emergency implementations, as in the current crisis [ 21 ].…”

Service user experiences and views regarding telemental health during the COVID-19 pandemic: a co-produced framework analysis

“…An example are people experiencing significant social disadvantage or severe mental health problems including psychosis have been reported to benefit less from telemental health [45]. Evidence is lacking both on the extent of digital exclusion and on how it might be overcome [21]. Barriers to access care such as those described in Subtheme 1.2 may help to explain why, despite its robust research evidence base and the strategic focus in England on more effective integration of digital technologies across the NHS [46], implementation of telemental health had remained very limited prior to the pandemic in England and in other countries with similar mental health systems [1].…”