JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contacts became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to tele-mental health worldwide.

Objective:

We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic.

Methods:

We searched systematically for quantitative papers focussing on the impact of the COVID-19 pandemic on mental health services published until the 13th of April 2021, accessing PubMed, EMBASE, medRxiv and bioXriv electronic bibliographic databases using the COVID-19 Open Access Project online platform. After the screening process and the data extraction, findings were summarised narratively in the context of each country’s COVID-19 stringency index, which reflects the stringency of a government’s response to COVID-19 restrictions at a specific time.

Results:

Of the identified 24339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that in several countries’ face-to-face services reduced their activities at the start of the pandemic, with a reduction in the total number of delivered visits and some services forced to close. In contrast, the use of tele-mental health rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualisation of general and specialistic care services by the end of the first year. In light of the reported COVID-19 stringency indexes, the increased use of virtual means seems to correspond to periods when stringency indexes were at their highest in several countries. However, due to specific care requirements, the use of tele-mental health could not be applied to certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits.

Conclusions:

During the pandemic mental health services have had to adapt quickly in the short-term, implementing or increasing the use of tele-mental health services across the globe. In the long-term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and competences of patients, may better support the future development of mental health services. This will require confidence, training, and experience in all modalities for both clinicians and service-users.