The COVID-19 pandemic has led to rapid changes in mental health care, and the move to telemedicine is likely here to stay, but new research from the U.K. reveals that major challenges still need to be addressed.
The research involves two new studies led by the University College London (UCL) and King’s College London for the NIHR Mental Health Policy Research Unit (MHPRU). The papers are published in the journals Social Psychiatry and Psychiatric Epidemiology.
One study is a survey of 2,180 mental health professionals in the U.K., and the other is an international review of 872 papers and articles across six continents.
“People working in mental health care settings across the U.K. and globally have reported rapid innovation at their workplaces, including the rapid adoption of telemedicine, after years of slow progress,” said the director of the MHPRU, Professor Sonia Johnson (UCL Psychiatry and Camden and Islington NHS Foundation Trust), corresponding author of both studies.
“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.”
The international review identified multiple reports showing that the pandemic worsened symptoms for people with mental health issues. Many people had increased anxiety due to concerns about getting infected, while others struggled with the loss of routine, or social isolation and loneliness. Several studies raised concerns that social adversities and inequalities may continue to worsen.
Globally, mental health professionals anticipate a greater need for services as the pandemic drags on, which could be coupled with reduced capacity and 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.
“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,” said 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.
“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.”
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.
“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,” said Dr. Luke Sheridan Rains (UCL Psychiatry), co-first author of the international paper.
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 U.K. survey, the authors note that a key challenge continues to be managing to combine infection control with a good therapeutic environment. Several 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.
“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,” said Christian Dalton-Locke (UCL Psychiatry), co-first author of the paper.
Source: University College London
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