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

  1. Elisa Liberati
  2. Natalie Richards
  3. Jennie Parker
  4. Janet Willars
  5. David Scott
  6. Nicola Boydell
  7. Vanessa Pinfold
  8. Graham Martin
  9. Mary Dixon-Woods
  10. Peter Jones

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Abstract

To explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.

Design

Qualitative interview study, codesigned with mental health service users and carers.

Methods

We 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.

Setting

National Health Service (NHS) secondary mental health services in England between June and August 2020.

Participants

Of 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.

Results

Experiences 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.

Conclusions

Though 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.

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  1. Version published to 10.1136/bmjopen-2021-049210
  2. ScreenIT

    SciScore for 10.1101/2021.01.18.21250032: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Once registered on Thiscovery, potential participants were given further information and invited to complete the informed consent form.
    IRB: Ethical approval for the study was obtained from the University of Cambridge Psychology Research Ethics Committee on 15 June 2020.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableData was processed using NVIVO software by five coders (four females and one male, DS).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data was processed using NVIVO software by five coders (four females and one male, DS).
    NVIVO
    suggested: (NVivo, RRID:SCR_014802)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This finding underscores the limitations of the current evidence on video-based consultations as a substitute for in-person healthcare that, as Greenhalgh and colleagues note, relates almost exclusively to “highly selected samples of hospital outpatients with chronic, stable conditions.”23 Our study further challenges the transferability of the findings of this body of evidence to the mental health context, particularly for service users whose difficulties are fluctuating or who may find themselves in crisis. Our study has strengths and weaknesses. As a qualitative study, it relies on accounts of behaviours, practices, experiences and opinions as reported by participants, cannot take into account the clinical or personal outcomes of remote care, or infer causal relationships between these and the various features of remote care identified. Furthermore, we did not recruit people attempting to access mental healthcare for the first time. Among the study’s strengths are its large and varied sample and its novelty in exploring remote care for mental health during a pandemic from the perspective of service users, service providers and family carers. We acknowledge that the methods of online recruitment and engagement used in the study will have created some barriers for some groups; the approach favoured those to whom we could reach out with information about the study, as well as those with the necessary resource and capacity to decide whether or not to take part in the interview...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.01.18.21250032 on medRxiv