scholarly journals Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257270
Author(s):  
Norha Vera San Juan ◽  
Prisha Shah ◽  
Merle Schlief ◽  
Rebecca Appleton ◽  
Patrick Nyikavaranda ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Data Collection ◽  
Service User ◽  
Telemental Health ◽  
Service Users ◽  
Framework Analysis ◽  
Face To Face ◽  
Digital Exclusion ◽  
Remote Care

Background The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. Methods We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants’ experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. Findings The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants’ preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties’ access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. Discussion Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.

scholarly journals Service user experiences and views regarding telemental health during the COVID-19 pandemic: a co-produced framework analysis

2021 ◽  
Author(s):  
Norha Vera San Juan ◽  
Prisha Shah ◽  
Merle Schlief ◽  
Rebecca Appleton ◽  
Patrick Nyikavaranda ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Data Collection ◽  
Service User ◽  
Telemental Health ◽  
Service Users ◽  
Framework Analysis ◽  
Face To Face ◽  
Digital Exclusion ◽  
Remote Care

AbstractBackgroundThe prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in accessing good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable.MethodsWe conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants’ experiences and views regarding telemental health during the pandemic was identified and extracted. Data collection and analysis used a participatory, coproduction approach where lived experience researchers, clinical and academic researchers contributed to all stages of data collection, analysis and interpretation of findings.FindingsParticipants’ experiences and preferences regarding telemental health care were dynamic and varied across time, settings, and individuals. Participants’ preferences were shaped by the reason for contacting providers, their relationship with the care provider, and both parties’ access or acceptability to use remote technology. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important new challenges around safety and privacy in online settings, and gave examples of good remote care strategies, including scheduling regular phone calls and developing guidelines about how to access remote care tools.DiscussionParticipants in our study and previous literature have highlighted advantages of telemental health care, as well as significant limitations which hinder mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and to support staff in making effective and collaborative use of relevant technologies.

scholarly journals Combining online and offline peer support groups in mental health care: A qualitative study of service users� experiences (Preprint)

2018 ◽  
Author(s):  
Monica Strand ◽  
Deede Gammon ◽  
Lillian Sofie Eng ◽  
Cornelia Ruland
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Support Groups ◽  
Local Community ◽  
Mental Health Problems ◽  
Service Users ◽  
Face To Face ◽  
Individual Interviews

BACKGROUND Peer support groups for people with long-term mental health problems are at the heart of recovery-oriented approaches in mental health care. When conducted face-to-face (offline) or on the Internet (online), peer support groups have proven to have differing strengths and weaknesses. Little is known about the benefits and challenges of combining the two formats. OBJECTIVE The aim of this study was to gain insights into the benefits and challenges of combining online and offline peer support groups facilitated through an Internet intervention designed to support recovery processes. METHODS In this exploratory and descriptive study, an e-recovery portal called ReConnect was used by service users in two mental health communities in Norway for 6-12 months. The portal included an online peer support forum which also facilitated participation in local in-person ReConnect-cafés. Both formats of peer support were facilitated by an employed service user consultant with lived experience of mental health problems and with training in peer support. Qualitative data about service users’ experiences of using the portal were collected through focus groups and individual interviews and inductively analyzed thematically with focus on benefits and challenges of peer support online and offline. RESULTS A total of 14 service users 22-63 years of age with various diagnoses, receiving services at both primary and specialist levels of mental health care participated in three focus groups and 10 individual interviews. Two main themes were identified in the analysis: 1) balancing anonymity and openness, and 2) enabling connectedness. These themes are further illustrated with the subthemes: i) dilemmas of anonymity and confidentiality, ii) towards self-disclosure and openness, iii) new friendships, and iv) networks in the local community. Three of the subthemes mainly describe benefits. Challenges were more implicit and cut across the subthemes. Identified challenges were linked to transitions from anonymity to revealing one’s identity, how to protect confidentiality, or to participation at face-to-face meetings in the local community. CONCLUSIONS Our study suggests that online peer support groups and offline meetings complement each other, and the combination is mainly beneficial to users. The identified benefits appeared to arise from participants’ options of one format or the other, or that they could combine formats in ways that suited their individual values and comfort zones. We also identified challenges related to combination of formats, and both formats require appropriate facilitation of peer support. Combining online formats that enable anonymity, a non-judgmental atmosphere, and 24/7 accessibility regardless of location, with offline formats that foster local, in-person community ties, is a promising concept for facilitating recovery-oriented care, and warrants continued research.

scholarly journals Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review (Preprint)

2021 ◽  
Author(s):  
Rebecca Appleton ◽  
Julie Williams ◽  
Norha Vera San Juan ◽  
Justin J Needle ◽  
Merle Schlief ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Rural Areas ◽  
Emergency Situation ◽  
Models Of Care ◽  
Phone Call ◽  
Telemental Health ◽  
Service Users ◽  
Optimal Care

BACKGROUND Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. OBJECTIVE To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. METHODS Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. RESULTS A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. CONCLUSIONS Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. CLINICALTRIAL PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025

scholarly journals Involvement in Mental Health and Substance Abuse Work: Conceptions of Service Users

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Minna Laitila ◽  
Merja Nikkonen ◽  
Anna-Maija Pietilä
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Substance Abuse ◽  
Data Analysis ◽  
Service User ◽  
User Involvement ◽  
Service Users ◽  
Service User Involvement

Service user involvement (SUI) is a principal and a guideline in social and health care and also in mental health and substance abuse work. In practice, however, there are indicators of SUI remaining rhetoric rather than reality. The purpose of this study was to analyse and describe service users' conceptions of SUI in mental health and substance abuse work. The following study question was addressed: what are service users' conceptions of service user involvement in mental health and substance abuse work? In total, 27 users of services participated in the study, and the data was gathered by means of interviews. A phenomenographic approach was applied in order to explore the qualitative variations in participants' conceptions of SUI. As a result of the data analysis, four main categories of description representing service users' conceptions of service user involvement were formed: service users have the best expertise, opinions are not heard, systems make the rules, and courage and readiness to participate. In mental health and substance abuse work, SUI is still insufficiently achieved and there are obstacles to be taken into consideration. Nurses are in a key position to promote and encourage service user involvement.

scholarly journals Psychiatric drugs: reconsidering their mode of action and the implications for service user involvement

2019 ◽  
Vol 24 (1) ◽  
pp. 1-10
Author(s):  
Marc Roberts
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Service ◽  
Health Service ◽  
Service User ◽  
User Involvement ◽  
Service Users ◽  
Service User Involvement ◽  
Content Type ◽  
Psychiatric Drugs

Purpose The purpose of this paper is to examine two competing pharmacological models that have been used to understand how psychiatric drugs work: the disease-centred model and the drug-centred model. In addition, it explores the implications of these two models for mental health service users and the degree to which they are meaningfully involved in decisions about the use of psychiatric drugs. Design/methodology/approach The approach is a conceptual review and critical comparison of two pharmacological models used to understand the mode of action of psychiatric drugs. On the basis of this analysis, the paper also provides a critical examination, supported by the available literature, of the implications of these two models for service user involvement in mental health care. Findings The disease-centred model is associated with a tendency to view the use of psychiatric drugs as a technical matter that is to be determined by mental health professionals. In contrast, the drug-centred model emphasises the centrality of the individual experience of taking a psychiatric drug and implies a more equitable relationship between practitioners and mental health service users. Originality/value Although infrequently articulated, assumptions about how psychiatric drugs work have important consequences for service user involvement in mental health care. Critical consideration of these assumptions is an important aspect of seeking to maximise service user involvement in decisions about the use of psychiatric drugs as a response to their experience of mental distress.

scholarly journals Early Psychosis Service User Views on Digital Technology: Qualitative Analysis (Preprint)

2018 ◽  
Author(s):  
Sandra Bucci ◽  
Rohan Morris ◽  
Katherine Berry ◽  
Natalie Berry ◽  
Gillian Haddock ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Digital Technology ◽  
Service User ◽  
Care Delivery ◽  
Digital Health ◽  
Early Psychosis ◽  
Treatment Modalities ◽  
Future Research ◽  
Service Users

BACKGROUND Digital technology has the potential to improve outcomes for people with psychosis. However, to date, research has largely ignored service user views on digital health interventions (DHIs). OBJECTIVE The objective of our study was to explore early psychosis service users’ subjective views on DHIs. METHODS Framework analysis was undertaken with data obtained from 21 semistructured interviews with people registered with early intervention for psychosis services. Robust measures were used to develop a stable framework, including member checking, triangulation, independent verification of themes, and consensus meetings. RESULTS The following 4 themes were established a priori: acceptability of technology in psychosis and mental health; technology increasing access to and augmenting mental health support; barriers to adopting DHIs; and concerns about management of data protection, privacy, risk, and security of information. The following 2 themes were generated a posteriori: blending DHIs with face-to-face treatment and empowerment, control, and choice. DHIs were also viewed as potentially destigmatizing, overcoming barriers faced in traditional service settings, facilitating communication, and empowering service users to take active control of their health care. CONCLUSIONS In the first study of its kind, early psychosis service users’ were largely positive about the potential use of DHIs supporting and managing mental health. Overall, service users felt that DHIs were a progressive, modern, and relevant platform for health care delivery. Concerns were expressed around privacy and data security and practical barriers inherent within DHIs, all of which require further attention. Future research should explore whether findings transfer to other service user groups, other technology delivery formats, and across a range of treatment modalities.

scholarly journals Implementation, adoption and perceptions of telemental health during the COVID-19 pandemic: a systematic review

2021 ◽  
Author(s):  
Rebecca Appleton ◽  
Julie Williams ◽  
Norha Vera San Juan ◽  
Justin Needle ◽  
Merle Schlief ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Rural Areas ◽  
Emergency Situation ◽  
Models Of Care ◽  
Phone Call ◽  
Telemental Health ◽  
Service Users ◽  
Optimal Care

Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health, and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 Pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesised using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these.

Remote continuous care is superior to episodic care for depression: Digital health is the only way to deliver it (Preprint)

2020 ◽  
Author(s):  
VALERIE FORMAN HOFFMAN ◽  
Joseph Kvedar ◽  
Kristian Ranta
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Digital Health ◽  
Single Treatment ◽  
Disease Treatment ◽  
Face To Face ◽  
Optimal Outcomes ◽  
Continuous Care ◽  
Remote Care ◽  
Delivery Models

UNSTRUCTURED Abstract Depression is a burdensome and costly disease. Treatment is not sought by over half of depressed patients, and many who suffer remain depressed despite treatment. Furthermore, there is no single treatment efficacious for all patients, with optimal outcomes precluded by access, adherence, and patient satisfaction issues. The recent proliferation of telehealth solutions has increased access to care, especially during the COVID pandemic, but problems with several of its traditional types of delivery models still exist. Rather than the provision of traditional episodic mental health care, creative mental health solutions that can provide continuous care with frequent patient-provider interactions are urgently needed. This Viewpoint explores how digital health solutions enable the provision of continuous types of remote care to provide relief for some of the access and capacity problems exacerbated by requirements for face-to-face types of care.

scholarly journals Peer Supported Open Dialogue in the National Health Service: Implementing and Evaluating a New Approach to Mental Health Care

2021 ◽  
Author(s):  
Catherine Kinane ◽  
James Osborne ◽  
Yasmin Ishaq ◽  
Marcus Colman ◽  
Douglas MacInnes
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Social Network ◽  
Mental Health Care ◽  
Service User ◽  
Service Users ◽  
Full Time ◽  
High Satisfaction ◽  
Bed Days ◽  
Open Dialogue

Abstract BackgroundOpen Dialogue, an approach to mental health care which is based on collaboration between an individual and their family and social network, originated in Western Lapland in the 1980’s and has been developing internationally. Our quest for better approaches to Mental Health Care with improved carer and service user experience led us to develop and test a model of Peer Supported Open Dialogue (POD). There is no research currently looking at the impact of a standalone POD model in an NHS community team so this study evaluates its implementation, clinical effectiveness and value to service users, their families and NHS staff. Method50 service users treated by the POD Team were recruited with additional participants from family and wider social network. Questionnaires covering wellbeing, functioning, satisfaction were collected through validated scales completed at baseline, three and six months. Data regarding adherence was collected following each network meeting. Data from electronic medical records was collected looking at functioning, contact rate, those in employment or full-time education and the mean bed days per episode of care between service users receiving POD compared to traditional services. Results Service users treated were young people with a mean age of 35 years, slightly more males than females. The approach was effective on service user reported measures of wellbeing and functioning. Clinician reported measure showed better outcomes than treatment as usual at the six month point. There was a marked increase in perceived support by carers which increased across the study. Over half the meetings were attended by carers. The POD group had greater face to face contact, longer contact times and an important clinical difference in the number of bed days used. Clinician adherence to the model was very high. The Community Mental Health Survey showed high satisfaction rates for service users including carer involvement.Conclusions It was possible to transform to deliver a clinically effective POD service in the NHS. This innovative approach provided continuity of care within the social network, with improved carer support and high satisfaction for service users, carers and clinicians.Trial registration: (isrctn.com/ISRCTN36004039. Retrospectively registered 04 January 2019.

scholarly journals Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Joanna Fox
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Shared Decision Making ◽  
Service User ◽  
Treatment Options ◽  
Service Users ◽  
Shared Decision ◽  
Care And Treatment

Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a discharge planning meeting; and secondly, the choice to take medication over the long-term, despite the side effects. The article will explore both opportunities and barriers to effective shared decision-making, as well as skills and processes to facilitate this approach. The need to balance power between service users and professionals in this interaction is highlighted, including the need to respect expertise built on lived experience, alongside that of clinical expertise. This narrative is framed within an autoethnographic approach which allows me to contextualize my personal experiences in the wider environment of mental health care and support.

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