Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic
Authors: Liberati Elisa , Richards Natalie , Parker Jennie , Willars Janet , Scott David , Boydell Nicola , Pinfold Vanessa , Martin Graham , Dixon-Woods Mary , Jones Peter B 
Published: January 2021

Objectives

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, co-designed with mental health service users and carers.

Methods

We conducted semi-structured, telephone or online interviews with a purposively constructed sample; a peer researcher with lived experience conducted and analysed interviews with service users. Analysis was based on the constant comparison method.

Setting

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 wellbeing. 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

Whilst 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 decisions about remote mental healthcare. 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.

ARTICLE SUMMARY

Strengths and limitations of this study

Strengths include its qualitative approach in speaking to a large sample of participants with varied mental health difficulties, carers, and a diverse range of mental healthcare staff.

Its novelty lies in a deep exploration of the views and experiences of remote mental healthcare during a pandemic.

The methods are strengthened by the involvement of experts-by-experience and the use of peer research methods.

We did not adopt a narrative method; the interviews were one-off conversations so we could not explore change as the pandemic progressed and people may have become accustomed to remote care.

The study used remote methods to comply with UK lockdown regulations; this will have excluded some groups without the ability to engage remotely.