Telemedicine: do not leave the digitally excluded behind

Telemedicine: do not leave the digitally excluded behind
iStock-Andrey Suslov

Telemedicine is set to outlast the COVID-19 pandemic according to mental health care experts, however, they have cautioned that this should be balanced with face-to-face care, ensuring those who may not have access to technology do not get left behind.

Healthcare has undergone rapid transformation since the start of the COVID-19 pandemic, including how health care services are delivered. Now, new research, led by UCL and King’s College London-led NIHR Mental Health Policy Research Unit (MHPRU), shows that COVID-19 has exacerbated mental health conditions for some, and that telemedicine should ensure the digitally excluded should not be left behind.

The researchers carried out a survey in the UK as well as an international review of evidence from 29 countries. Mental health care staff reported how the pandemic and lockdown have been harmful to some people accessing mental health services.

The studies have been published in Social Psychiatry and Psychiatric Epidemiology.

COVID-19 is impacting mental health

The international review identified reports that highlighted how the pandemic is making symptoms worse for people with mental health conditions.

Many people have experienced increased anxiety due to concerns about getting infected, while others have struggled with the loss of routine, or social isolation and loneliness. Numerous studies raised concerns that social adversities and inequalities may continue to worsen.

The researchers caution that the ‘digitally excluded’ are in danger of not receiving the care they need.

Director of the MHPRU, Professor Sonia Johnson, 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.”

Telemedicine should complement face-to-face care

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

Respondents to the survey 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-focussed 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, 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.”

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