The pros and cons of telemental health – EurekAlert

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King's College London
New research led by the National Institute for Health & Care Research (NIHR) Mental Health Policy Research Unit (MHPRU) at King’s College London and University College London (UCL), has shown that certain groups of people benefit from the freedom of choice that telemental health provides, but this is not true for all.
The research, published today in the Interactive Journal of Medical Research, investigates which telemental health approaches work (or do not work) for whom, in which contexts, and through which mechanisms. Telemental health was found to be effective overall, but researchers highlight that there is no ‘one size fits all’.
Telemental health (or telemedicine) is mental health care – patient care, administrative activities and health education – delivered via ‘telecommunications technologies’ e.g.  video calls, telephone calls or SMS text messages. It has become increasingly widespread, as it can be useful in providing care to service users in remote communities, or during an emergency restricting face-to-face contact, such as the COVID-19 pandemic.
The study found telemental health can be effective in reducing treatment gaps and barriers, by improving access to mental health care across different service user groups (e.g. adult, child and adolescent, older adults, and ethnic minority groups) and across personal contexts (e.g. difficulty accessing services, caring responsibilities or condition). However, it is crucial that providers consider that there are a set of key factors which lead to variations in peoples’ response to telemental health; for example, variations in access to a private and confidential space, ability to develop therapeutic relationships, individual preferences and circumstances as well as the internet connection quality.
King’s researcher Dr Katherine Saunders, from NIHR MHPRU and joint lead author said, “We live in an increasingly digital world, and the COVID-19 pandemic accelerated the role of technology in mental health care. Our study found that, while certain groups do benefit from the opportunities telemental health can provide, it is not a one size fits all solution. Receiving telemental health requires access to a device, an internet connection and an understanding of technology. If real world barriers to telemental health are ignored in favour of wider implementation, we risk further embedding inequalities into our healthcare system.”
Important limitations have been reported that implementing telemental health could risk the reinforcement of pre-existing inequalities in service provision. Those who benefit less are people without access to internet or phone, those experiencing social and economic disadvantages, cognitive difficulties, auditory or visual impairments, or severe mental health problems (such as psychosis).
Professor Sonia Johnson from UCL and Director, NIHR MHPRU and senior author adds “Our research findings emphasise the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation. For those people, we recommend a need to ensure that face-to-face care of equivalent timeliness remains available”
The authors suggest the findings have implications across the board of clinical practice, service planning, policy and research. If telemental health is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed.
Professor Alan Simpson, from King’s and Co-Director, NIHR MHPRU concludes “As well as reviewing a huge amount of research literature, in this study we also involved and consulted with many clinicians and users of mental health services. This included young people, those that worked in or used inpatient and crisis services, and those who had personal lived experience of telemental throughout the pandemic. This gives this research a relevance that will be of interest to policy makers, service providers and those working in and using our services.”
Merle Schlief, joint lead author from NIHR MHPRU at UCL saidWorking entirely online to conduct this study gave us access to experts and stakeholders who we simply would not have been able to include if we had been working in-person, including people living and working internationally, and those who would have been unable to travel. This highlights one of the key strengths of technology.”
The authors recommend that guidelines and strategies are co-produced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings.
The MHPRU is a joint enterprise between researchers at UCL and King’s College London with a national network of collaborators. We conduct research commissioned by the NIHR Policy Research Programme to help the Department of Health and Social Care and others involved in making nationwide plans for mental health services to make decisions based on good evidence. The MHPRU contributed research evidence to the national review of the Mental Health Act and is currently undertaking a number of studies.
This paper presents independent research commissioned and funded by the NIHR Policy Research Program.
Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review (DOI: 10.2196/38239) was published in the Interactive Journal of Medical Research.
For more information, please contact Patrick O’Brien (Senior Media Officer)
Notes to editors
About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience 
King's College London is one of the top 35 universities in the world and one of the top 10 in Europe (QS World University Rankings, 2021/22) and among the oldest in England. King's has more than 33,000 students (including more than 12,800 postgraduates) from over 150 countries worldwide, and 8,500 staff. King's has an outstanding reputation for world-class teaching and cutting-edge research.
The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s is the premier centre for mental health and neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on psychiatry and mental health than any other centre (SciVal 2021), and on this metric has risen from 16th (2014) to 4th (2021) in the world for highly cited neuroscience outputs. In the 2021 Research Excellence Framework (REF), 90% of research at the IoPPN was deemed ‘world leading’ or ‘internationally excellent’ (3* and 4*). World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness, neurological conditions, and other conditions that affect the brain. | Follow @KingsIoPPN on Twitter, Instagram, Facebook and LinkedIn
About UCL – London’s Global University
UCL is a diverse global community of world-class academics, students, industry links, external partners, and alumni. Our powerful collective of individuals and institutions work together to explore new possibilities.
Since 1826, we have championed independent thought by attracting and nurturing the world's best minds. Our community of more than 43,800 students from 150 countries and over 14,300 staff pursues academic excellence, breaks boundaries and makes a positive impact on real world problems.
We are consistently ranked among the top 10 universities in the world and are one of only a handful of institutions rated as having the strongest academic reputation and the broadest research impact.
We have a progressive and integrated approach to our teaching and research – championing innovation, creativity and cross-disciplinary working. We teach our students how to think, not what to think, and see them as partners, collaborators and contributors.  
For almost 200 years, we are proud to have opened higher education to students from a wide range of backgrounds and to change the way we create and share knowledge.
We were the first in England to welcome women to university education and that courageous attitude and disruptive spirit is still alive today. We are UCL. | Follow @uclnews on Twitter | Read news at | Listen to UCL podcasts on SoundCloud | Find out what’s on at UCL Minds
About the National Institute for Health and Care Research (NIHR)
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
Interactive Journal of Medical Research
Systematic review
Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review
RRO is a member of King’s Improvement Science, which offers co-funding to the National Institute for Health Research Applied Research Collaboration South London, and is funded by King’s Health Partners (Guy’s and St Thomas’ National Health Service [NHS] Foundation Trust, King’s College Hospital; NHS Foundation Trust, King’s College London; and South London and Maudsley NHS Foundation Trust) and Guy’s and St Thomas’ Foundation.
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Media Contact
Patrick O’Brien
King's College London
[email protected]
Office: 07-813-706-151

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Copyright © 2022 by the American Association for the Advancement of Science (AAAS)


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