TY - JOUR
T1 - Remote mental health care interventions during the COVID-19 pandemic
T2 - An umbrella review
AU - Witteveen, A. B.
AU - Young, S.
AU - Cuijpers, P.
AU - Ayuso-Mateos, J. L.
AU - Barbui, C.
AU - Bertolini, F.
AU - Cabello, M.
AU - Cadorin, C.
AU - Downes, N.
AU - Franzoi, D.
AU - Gasior, M.
AU - John, A.
AU - Melchior, M.
AU - McDaid, D.
AU - Palantza, C.
AU - Purgato, M.
AU - van der Waerden, J.
AU - Wang, S.
AU - Sijbrandij, M.
N1 - Funding Information:
We are grateful for the support of dr. Mark van Ommeren and dr. Brandon Gray of the Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland. We also like to thank Olivia Zurcher for her support in organizing the flow-chart of studies.
Funding Information:
The World Health Organization , Geneva, Switzerland and the RESPOND project funded under Horizon 2020 – the Framework Programme for Research and Innovation (2014–2020). The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein.
Funding Information:
Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.As shown in Table 1, in the majority of reviews (k = 32) the main adaptation to the pandemic was implementing sTMH interventions for outpatient or community care (i.e. consultation and counseling of psychotherapy or psychotropic medication prescriptions and follow-ups through telephone or video-conferencing platforms). Earlier in the pandemic, implementation of aVMH care appeared mostly limited to online provision of psycho-educational self-help materials (Clemente-Suárez et al., 2021; Meloni, de Girolamo, & Rossi, 2020; Raphael, Winter, & Berry, 2021; Yue et al., 2020) or clinical decision assessment tools through internet or e-mail (Abd-Alrazaq et al., 2021; Fornaro et al., 2021). Few reviews reported implementation of a combination of both sTMH care and aVMH tools or interventions. Transition to aVMH interventions such as i-CBT or psychosocial support apps for healthcare workers or recovering COVID-19 patients, appeared much less prevalent and often conducted later in the pandemic (Bertuzzi et al., 2021; Hatami et al., 2022; Soklaridis, Lin, Lalani, Rodak, & Sockalingam, 2020). Reviews examining uptake of sTMH care noted, after an initial slight decrease in appointments, an increase in remote therapy sessions and consultations even beyond pre-pandemic levels, with better adherence and decreased no-shows (Li et al., 2021; Siegel, Zuo, Moghaddamcharkari, McIntyre, & Rosenblat, 2021). In general, accessibility in more vulnerable patient populations and in those needing a support person present to facilitate remote sessions were found to be more limited. In these instances, telephone calls were seen as the second best solution, particularly for people of low SES (Socio-Economic Status) (Li et al., 2021; Selick et al., 2021; Siegel et al., 2021).In terms of inner settings, absence of organizational support for technological implementation of sTMH or aVMH due to a lack of technological equipment, inadequate IT infrastructure and time constraints for personnel to properly use these technologies, as well as lack of funding and resources, were often found barriers during COVID-19. Fewer reviews reported positive aspects such as technical support and knowledge from the organization (e.g. good quality internet, computer in private area and (user-)guidelines) during COVID-19. Organizational barriers in terms of the outer setting (Damschroder et al., 2009) (i.e. patients using sTMH or aVMH) were limited confidentiality, other safety/security issues and lack of privacy for the patient. Visibility of the home environment was however also found to be a facilitator of using TMH care because of additional insight into socio-environmental determinants. In terms of access to care made available by organizations for subgroups of patients, there were mixed findings on whether the removal of regulatory barriers facilitating access to care. Some had increasing or decreasing access to TMH and VMH care for marginalized or vulnerable populations. Barriers in terms of active implementation processes during the pandemic, revolved around the failed technological integration of sTMH and aVMH care into organizational and national systems, health insurance funding issues and limited sustainability and adoption due to lack of involvement of stakeholders. Furthermore, a lack of (culturally adapted) training and shortage of trained or skilled staff was found to be a barrier, although other reviews presented findings with well-trained staff with a higher level of achievement.The World Health Organization, Geneva, Switzerland and the RESPOND project funded under Horizon 2020 – the Framework Programme for Research and Innovation (2014–2020). The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein.
Publisher Copyright:
© 2022 The Authors
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.
AB - Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.
KW - COVID-19
KW - Continuity of care
KW - Implementation
KW - Mental health service delivery
KW - Scalability
KW - e-mental health psychological interventions
UR - https://www.scopus.com/pages/publications/85142126770
U2 - 10.1016/j.brat.2022.104226
DO - 10.1016/j.brat.2022.104226
M3 - Article
C2 - 36410111
SN - 0005-7967
VL - 159
JO - Behaviour research and therapy
JF - Behaviour research and therapy
M1 - 104226
ER -
SDG 3 Good Health and Well-being