JMIR Publications

ABSTRACT

Background:

In England, as elsewhere, COVID-19 has significantly affected mental health care and tested the resilience of providers. In many areas, the increased use of information and digital technology has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision.

Objective:

We assessed the use and impact of information and digital technology on the quality and efficiency of mental health service provision during the pandemic. We drew on socio-technical systems (STS) theory as a conceptual framework to help structure data gathering, analysis and interpretation.

Methods:

We undertook a national scoping study which involved documentary analysis and semi-structured interviews with six national stakeholders and case studies of four purposefully selected mental health providers in England involving interviews with 53 staff

Results:

Following the outbreak of COVID-19 mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. Informants provided nuanced perspectives regarding the impact on quality and efficiency of enhanced digital and telephone service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Chief among its downsides are concerns around the unsuitability of remote consultation for some people with mental health conditions and a digital divide/poverty exacerbating existing inequalities. STS theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors which influence the use of technology and shape mental health care delivery in times of crisis and normalcy.

Conclusions:

While the use of information technology (IT) has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. On the other hand patient choice was often compromised and patient experience/outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. Yet, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires further and more sustained research.