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

Abstract

Background The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. Methods We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants’ experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. Findings The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants’ preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties’ access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. Discussion Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.

Exploring Access to Mental Health and Primary Care Services for People With Severe Mental Illness During the COVID-19 Restrictions

“…Overall then, our study found that the majority of people with SMI were able to access support but those who received remote support were less likely to be satisfied with that support. Furthermore, the context of remote support was important, a finding supported in a recent study by Vera San Juan et al (15). This suggests that if, as seems likely, service providers continue to employ some element of remote care, service users should have a choice about whether they want remote care and the mode of remote support they receive.…”

Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review

“…We used the higher-level CFIR constructs (see Table 2 in section Barriers and Facilitators to Telemental Health for a brief definition of each one of the implementation facets that CFIR constructs capture) to extract data on factors influencing implementation success [ 38 ], and the taxonomy of implementation outcomes including acceptability, adoption, and feasibility. We also extracted information deemed relevant based on previous studies conducted by the research team, including an umbrella review of pre-COVID-19 systematic reviews on telemental health and a qualitative study [ 15 , 21 ]. Data extracted consisted of study details, including design and focus of study; gender, ethnicity, age; diagnosis of participants; details of staff occupation; setting and context of study; intervention details, implementation outcomes (including acceptability, adoption, appropriateness, feasibility, fidelity, cost effectiveness, penetration, and sustainability); barriers and facilitators to implementation; and clinical and safety outcomes.…”

“…Technological barriers to the wider adoption of telemental health include (1) the risk of digital exclusion of some service users, such as those facing significant social disadvantage or with limited technological access and expertise, and (2) the lack of technological infrastructure and clear protocols within services, impeding the integration of telemental health with face-to-face care [ 4 , 21 , 22 ]. Other barriers include difficulty in establishing and maintaining therapeutic relationships and in conducting high-quality assessments; service users who lack private space or find participating in sometimes intimate and distressing discussions from home intrusive [ 4 , 11 , 12 , 18 , 21 - 23 ]. A range of other ethical, regulatory, technological, cultural, and organizational barriers have also been identified, both before and during the pandemic [ 12 , 24 - 27 ].…”

Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review (Preprint)

“…We used the higher-level CFIR constructs (see Table 2 in section Barriers and Facilitators to Telemental Health for a brief definition of each one of the implementation facets that CFIR constructs capture) to extract data on factors influencing implementation success [38], and the taxonomy of implementation outcomes including acceptability, adoption, and feasibility. We also extracted information deemed relevant based on previous studies conducted by the research team, including an umbrella review of pre-COVID-19 systematic reviews on telemental health and a qualitative study [15,21].…”

“…Technological barriers to the wider adoption of telemental health include (1) the risk of digital exclusion of some service users, such as those facing significant social disadvantage or with limited technological access and expertise, and (2) the lack of technological infrastructure and clear protocols within services, impeding the integration of telemental health with face-to-face care [4,21,22]. Other barriers include difficulty in establishing and maintaining therapeutic relationships and in conducting high-quality assessments; service users who lack private space or find participating in sometimes intimate and distressing discussions from home intrusive [4,11,12,18,[21][22][23]. A range of other ethical, regulatory, technological, cultural, and organizational barriers have also been identified, both before and during the pandemic [12,[24][25][26][27].…”