Benefits and Challenges of Video Consulting for Mental Health Diagnosis and Follow-Up: A Qualitative Study in Community Care

Roles and Dynamics within Community Mental Health Systems During the COVID-19 Pandemic: A Qualitative Systematic Review and Meta-Ethnography

Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare's approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users' needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries' disaster mental health response and to invest in quality care, particularly for marginalized groups.

Association between continuity of care and attendance of post-discharge follow-up after psychiatric emergency presentation

The number of accident and emergency (A&E) hospital attendances by young people aged 18 or under with a recorded diagnosis of a psychiatric condition more than tripled between 2010 and 2022. After discharge from the hospital, attendance at follow-up appointments in the community is critical to ensure the safety of young people and optimise the use of clinical resources. A retrospective cohort study was conducted to evaluate the association between follow-up attendance and the continuity of clinicians and clinical teams, using electronic clinical record data from East London NHS Foundation Trust (ELFT), between April 2019 and March 2022. Multi-level mixed effects logistic regression was performed to model the follow-up attendance odds based on whether the same or different clinician and clinical team offered the initial A&E and the community follow-up appointment or whether a crisis team was involved. 3134 A&E presentations by 2368 young people were identified within the study period. Following these presentations, 2091 follow-up appointments in the community were offered. The attendance rate increased by more than three times if the follow-up appointment was offered by the same clinician who saw the young person in A&E (odds ratio (OR) = 3.66; 95% CI 1.65-8.13). Whether the same clinical team provided the community follow-up appointment, or whether a crisis team was involved before discharge made no difference to the likelihood of follow-up attendance. The findings support the importance of the continuity of clinicians in the care of young people in crisis.

Remote Communications between Patients and General Practitioners: Do Patients Choose the Most Effective Communication Routes?

The use of remote communication between patients and general practitioners has greatly increased worldwide, especially following the COVID-19 outbreak. Yet, it is important to evaluate the impact of this shift on healthcare quality. This study aimed at evaluating remote healthcare quality by comparing four remote patient-to-physician communication modes used in Israel. The research methodology entailed criteria-based analysis conducted by healthcare quality experts and a subjective patient-perception questionnaire regarding the healthcare quality attributed to each mode and the extent to which each mode was used. Our findings indicate that the extent to which each mode is used was found to be inversely related to its rated quality. As such, the common assumption whereby patients tend to choose the mode of communication that will most likely ensure high service quality is refuted. Our findings also indicate that remote services often hinder the physician's understanding of the patient's clinical issues, as patients encounter difficulties in correctly articulating and conveying them; such services also hinder the patient's understanding of the recommended course of treatment. These findings should be addressed by policymakers for improving remote communication services to ensure optimal healthcare service quality.

The intersection of technology and mental health: enhancing access and care

In recent times, technology has increasingly become a central force in shaping the landscape of mental health care. The integration of various technological advancements, such as teletherapy, virtual care platforms, mental health apps, and wearable devices, holds great promise in improving access to mental health services and enhancing overall care. Technology's impact on mental health care is multi-faceted. Teletherapy and virtual care have brought about a revolution in service delivery, eliminating geographical barriers and offering individuals convenient and flexible access to therapy. Mobile mental health apps empower users to monitor their emotional well-being, practice mindfulness, and access self-help resources on the move. Furthermore, wearable devices equipped with biometric data can provide valuable insights into stress levels and sleep patterns, potentially serving as valuable indicators of mental health status. However, integrating technology into mental health care comes with several challenges and ethical considerations. Bridging the digital divide is a concern, as not everyone has equal access to technology or the necessary digital literacy. Ensuring privacy and data security is crucial to safeguard sensitive client information. The rapid proliferation of mental health apps calls for careful assessment and regulation to promote evidence-based practices and ensure the delivery of quality interventions. Looking ahead, it is vital to consider future implications and adopt relevant recommendations to fully harness technology's potential in mental health care. Continuous research is essential to evaluate the efficacy and safety of digital interventions, fostering collaboration between researchers, mental health professionals, and technology developers. Proper training on ethical technology utilization is necessary for mental health practitioners to maintain therapeutic boundaries while leveraging technological advancements responsibly.