Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts
Open accessAbstract
BACKGROUND: The effects of COVID-19 on the shift to remote consultations remain to be properly investigated. OBJECTIVE: To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak. METHODS: We used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python. FINDINGS: Mental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18-21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients. CONCLUSIONS AND CLINICAL IMPLICATIONS: The rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.
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Access to psychotherapy is often hindered by stigmatization, physical distance, or long waiting times.
“Furthermore, access to psychotherapy is often hindered by e.g. stigmatization, physical distance, or long waiting times (Hong et al., 2021; World Health Organization, 2020; Backhaus et al., 2012; Simpson and Reid, 2014).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Hong et al., 2021
The Background describes telepsychiatry as care delivered at a distance, and the Discussion addresses barriers to using remote care. Neither passage says that stigma, physical distance, or long waits often hinder access to psychotherapy. Searches for those barriers and for psychotherapy access found no passage addressing the claim. (LLM, conf=0.75)
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“…mainly due to two reasons: First, pandemic-related restrictions such as social distancing or mask wearing mandates have resulted in an increased need for the remote delivery of therapeutic services, e.g., through video conferencing (Hong et al., 2021; World Health Organization, 2020).”
- Authors
- Hong, J. S., Sheriff, R., Smith, K., Tomlinson, A., Saad, F., Smith, T., Engelthaler, T., Phiri, P., Henshall, C., Ede, R., Denis, M., Mitter, P., D'Agostino, A., Cerveri, G., Tomassi, S., Rathod, S., Broughton, N., Marlowe, K., Geddes, J., & Cipriani, A.
- Affiliations
- University of Oxford (GB)
- Oxford Health NHS Foundation Trust (GB)
- Akrivia Health, Oxford Centre for Innovation, Oxford, UK
- Southern Health NHS Foundation Trust (GB)
- Oxford Brookes University (GB)
- Department of Health Sciences, University of Milan, Milano, Lombardia, Italy
- Aziende Socio Sanitarie Territoriale Lodi (IT)
- Azienda ULSS 9 Scaligera (IT)
- Corresponding author
- Cipriani, Andrea
- ORCID
- Venue
- Evidence-Based Mental Health
- Publisher
- BMJ
- Published
- 2021-09-28
- Volume
- 24
- Issue
- 4
- Pages
- 161-166
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC8483920
- OpenAlex
- W3198488271
- Cited by
- 32
- References
- 32
- Citations by year
- 2025: 8 · 2024: 3 · 2023: 11 · 2022: 10
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Evidence-Based Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Radar (Oxford Brookes University) (submittedVersion, cc-by)
- Funders
- NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005)
- Angelini Pharma (HQR02150)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- telepsychiatry, COVID-19 pandemic, teleconsultation, video consultation, mental health services, appointment attendance, dementia, Health of the Nation Outcome Scales, psychosis, organic mental disorders, service activities, clinical outcomes, post-lockdown recovery
- MeSH terms
- COVID-19, SARS-CoV-2, Communicable Disease Control, United Kingdom, Humans, Mental Health, Psychiatry, State Medicine, Telemedicine, Pandemics
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