The pros and cons of telemental health

The research, published today in the Interactive Journal of Medical Research, investigates which telemental health approaches work (or do not work) for whom, in which contexts, and through which mechanisms. Telemental health was found to be effective overall, but researchers highlight that there is no 'one size fits all'.

Telemental health (or telemedicine) is mental health care -- patient care, administrative activities and health education -- delivered via 'telecommunications technologies' e.g. video calls, telephone calls or SMS text messages. It has become increasingly widespread, as it can be useful in providing care to service users in remote communities, or during an emergency restricting face-to-face contact, such as the COVID-19 pandemic.

The study found telemental health can be effective in reducing treatment gaps and barriers, by improving access to mental health care across different service user groups (e.g. adult, child and adolescent, older adults, and ethnic minority groups) and across personal contexts (e.g. difficulty accessing services, caring responsibilities or condition). However, it is crucial that providers consider that there are a set of key factors which lead to variations in peoples' response to telemental health; for example, variations in access to a private and confidential space, ability to develop therapeutic relationships, individual preferences and circumstances as well as the internet connection quality.

King's researcher Dr Katherine Saunders, from NIHR MHPRU and joint lead author said, "We live in an increasingly digital world, and the COVID-19 pandemic accelerated the role of technology in mental health care. Our study found that, while certain groups do benefit from the opportunities telemental health can provide, it is not a one size fits all solution. Receiving telemental health requires access to a device, an internet connection and an understanding of technology. If real world barriers to telemental health are ignored in favour of wider implementation, we risk further embedding inequalities into our healthcare system."

Important limitations have been reported that implementing telemental health could risk the reinforcement of pre-existing inequalities in service provision. Those who benefit less are people without access to internet or phone, those experiencing social and economic disadvantages, cognitive difficulties, auditory or visual impairments, or severe mental health problems (such as psychosis).

Professor Sonia Johnson from UCL and Director, NIHR MHPRU and senior author adds "Our research findings emphasise the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation. For those people, we recommend a need to ensure that face-to-face care of equivalent timeliness remains available"

The authors suggest the findings have implications across the board of clinical practice, service planning, policy and research. If telemental health is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed.

Professor Alan Simpson, from King's and Co-Director, NIHR MHPRU concludes "As well as reviewing a huge amount of research literature, in this study we also involved and consulted with many clinicians and users of mental health services. This included young people, those that worked in or used inpatient and crisis services, and those who had personal lived experience of telemental throughout the pandemic. This gives this research a relevance that will be of interest to policy makers, service providers and those working in and using our services."

Merle Schlief, joint lead author from NIHR MHPRU at UCL said "Working entirely online to conduct this study gave us access to experts and stakeholders who we simply would not have been able to include if we had been working in-person, including people living and working internationally, and those who would have been unable to travel. This highlights one of the key strengths of technology."

The authors recommend that guidelines and strategies are co-produced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings.

The MHPRU is a joint enterprise between researchers at UCL and King's College London with a national network of collaborators. We conduct research commissioned by the NIHR Policy Research Programme to help the Department of Health and Social Care and others involved in making nationwide plans for mental health services to make decisions based on good evidence. The MHPRU contributed research evidence to the national review of the Mental Health Act and is currently undertaking a number of studies.