Telemedicine may well outlast the pandemic, say mental health care staff


Date:
August 19, 2020
Source:
University College London
Summary:
The COVID-19 pandemic has brought about rapid innovation in mental
health care, and the move to telemedicine is likely here to stay
to at least some degree, but new research cautions that serious
barriers still need to be overcome.



FULL STORY ==========================================================================
The Covid-19 pandemic has brought about rapid innovation in mental
health care, and the move to telemedicine is likely here to stay to at
least some degree, but new research led by UCL and King's College London cautions that serious barriers still need to be overcome.


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In a new survey in the UK and an international review of evidence from 29 countries, mental health care staff report how the pandemic and lockdown
have been harmful to some people accessing mental health services.

The two new studies are published in Social Psychiatry and Psychiatric Epidemiology and are led by the UCL- and KCL-led NIHR Mental Health
Policy Research Unit (MHPRU). One is a survey of 2,180 mental health professionals in the UK, and the other is a summary of reports from 872
papers and articles across six continents.

The international review identified multiple reports that the pandemic exacerbated symptoms for people with mental health conditions. Many people
had increased anxiety due to concerns about getting infected, while others struggled with the loss of routine, or social isolation and loneliness.

Numerous studies raised concerns that social adversities and inequalities
may continue to worsen.

Director of the MHPRU, Professor Sonia Johnson (UCL Psychiatry and Camden
and Islington NHS Foundation Trust), corresponding author of both studies, said: "People working in mental health care settings across the UK and
globally have reported rapid innovation at their workplaces, including
the rapid adoption of telemedicine, after years of slow progress.

"Most people we surveyed support partial adoption of remote working,
but they caution that telemedicine doesn't work for everyone, and there
are still major challenges to be addressed for it be truly effective. The voices of the digitally excluded are especially in danger of not being
heard." Internationally, mental health professionals anticipate an
increased need for services as the pandemic drags on, which could be
coupled with reduced capacity, with particular concerns for inpatient
and residential care settings.

Many expressed concerns that coping strategies that have helped people
through the lockdown may not be sustainable long-term.



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The researchers write that while there is not much official data available
yet, mental health care staff from numerous countries reported reduced referrals and visits to mental health services in the very early stages
of the pandemic.

Potential explanations include fears of infection, beliefs that help
would not be available, or concerns about being a burden.

The international survey also identified recurring ethical concerns about maintaining professional standards and human rights in a fast-changing environment. Some sources raised concerns that access to physical health
care has become inequitable for people with mental health conditions,
due to stigma and policies in some countries to keep them in psychiatric
units rather than general hospitals. Others have raised concerns that
mental health care might have become less ethical due to some new
restrictions and regulations.

In the UK survey, the authors note that a key challenge continues to be managing to combine infection control with a good therapeutic environment.

Numerous respondents raised concerns about difficulties with infection
control including problematic ward and office layouts, a lack of personal protective equipment (PPE) or of facilities for its proper use, and
some service users finding it difficult to understand and adhere to
social control.

Christian Dalton-Locke (UCL Psychiatry), co-first author of the UK-focused paper, said: "We found that balancing infection control requirements
with maintaining therapeutic relationships with patients who may be
distressed, suspicious, or struggling to comprehend the situation,
remains an important priority, and, as we have seen with reports of
Covid-19 deaths among people subject to the Mental Health Act, the price
of failure is potentially very high." MHPRU Co-Director, Professor Alan Simpson (King's College London's Institute of Psychiatry, Psychology & Neuroscience, Florence Nightingale Faculty of Nursing, Midwifery and
Palliative Care, and South London and Maudsley NHS Foundation Trust),
and senior author on both papers, said: "We found that in the UK and
in other countries, mental health care providers have demonstrated
considerable agility and flexibility in responding to the pandemic,
but staff remain concerned for the future.

"Regarding telemedicine, our sources have given a clear warning that substantial technological, social and procedural barriers remain, and
that its use should remain selective, complementing rather than replacing face-to-face contact." Dr Luke Sheridan Rains (UCL Psychiatry), co-first author of the international paper, said: "Mental health care staff in
many countries are concerned about a potential delayed wave of increased demand, putting strain on services with limited resources. The potential
long duration of the pandemic suggests that avoiding a crisis in mental
health care should be a global priority." The studies were funded by the National Institute for Health Research (NIHR) Policy Research Programme.


========================================================================== Story Source: Materials provided by University_College_London. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Luke Sheridan Rains, Sonia Johnson, Phoebe Barnett, Thomas Steare,
Justin
J. Needle, Sarah Carr, Billie Lever Taylor, Francesca Bentivegna,
Julian Edbrooke-Childs, Hannah Rachel Scott, Jessica Rees, Prisha
Shah, Jo Lomani, Beverley Chipp, Nick Barber, Zainab Dedat, Sian
Oram, Nicola Morant, Alan Simpson. Early impacts of the COVID-19
pandemic on mental health care and on people with mental health
conditions: framework synthesis of international experiences and
responses. Social Psychiatry and Psychiatric Epidemiology, 2020;
DOI: 10.1007/s00127-020-01924-7 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200819102809.htm

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