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The COVID-19 pandemic has affected millions of people around the world and its impact has reached well beyond physical health. Many are facing increasing mental health issues as lockdowns and social distancing measures continue to disrupt social interactions and day-to-day activities.

Mental healthcare providers have also had to adapt to these measures to keep servicing a growing need for support. Initiatives on social media platforms have been launched to raise awareness and encourage positive conversation around mental health, while solutions like telehealth were rapidly expanded to treat patients remotely.

While this shift happened suddenly as a reaction to a major health crisis, there are opportunities to retain these advances in access, awareness and availability of mental health services beyond COVID-19.

The impact of COVID-19 on mental health

The psychological effects of quarantine and social distancing have been likened to post-traumatic stress, which also displays symptoms of confusion and anger1. This has resulted in changes to behavioural patterns, decreased connection with others and the shutdown of usual day-to-day functioning.

The breadth and depth of COVID-19’s impact on mental health becomes clear as a recent Monash University study found that about 30 percent of participants reported moderate to high levels of anxiety and depression during COVID-192. Moreover, calls to mental health helplines increased by between 25 to 40 percent3, 4 , during quarantine5.

However, while reports suggest an increase in mental health issues, there has not been an equal rise in the use of mental health services. In Australia, the Federal Government has revealed that use of services is falling despite a rise in public anxiety and concern over the coronavirus pandemic6.

Raising awareness via social media

Although COVID-19 has been shown to negatively impact mental health, the widespread focus on people’s mental wellbeing during this period presents an opportunity to raise awareness.

Social media has been a key enabler in raising awareness for mental health, and has served to provide a medium to reach wider groups of people impacted by mental health issues. For example, the American Foundation for Suicide Prevention and Instagram recently ran a public awareness campaign to start conversations about mental health7. This initiative encouraged individuals to use the hashtag #RealConvo to discuss mental health on Instagram and aimed to empower them to access support resources if they needed it. The initiative also aimed to reduce stigma and feelings of isolation, and to reframe how people think of mental health.

The development of the National Mental Health and Wellbeing Pandemic Response Plan shows that mental health is also front of mind at the Australian Government. The response focuses on essential mental health services and support for all Australians, with a significant financial commitment of more than $120 million.

Telehealth and other virtual supports

The pandemic has seen a shift in the delivery of mental healthcare with an increasing number of patients receiving care online via video or phone. Previously, uptake of telehealth services in metropolitan areas had been low because the majority of funding was available only to patients in regional and remote areas8. Since the onset of COVID-19, funding for telehealth services has been made available to individuals in metropolitan areas ensuring that Australians needing mental health support can access it as well. The Government’s commitment includes a $680 million telehealth package to deliver care to all Australians during this challenging time.

Since the pandemic, the rise of telehealth in mental health service delivery reflects the benefits seen by both clinicians and patients. An American study which surveyed over 3,000 psychologists reported that the use of telehealth increased from 29 percent pre-COVID-19 to 83 percent after the onset of the crisis9. Further, almost three-quarters of survey respondents reported that they are likely to continue using telehealth in the near future8.

Outpatient mental health services have also been quick to embrace telehealth. In France, the pandemic has led to a 90 percent shift of outpatient and liaison psychiatry to telepsychiatry and this has been well received by patients, psychiatrists and psychologists10. Clinics in America have also made the move to virtual consultations. At UC Davis Health, the outpatient psychiatric clinic in which 98 percent of visits initially occurred in person, was converted to a telepsychiatry clinic within 3 business days11. Similarly, at the Cleveland Clinic, care was moved from mostly in-person medical appointments to all virtual/telemedicine care in a period of 2 weeks12. Patients appreciated the opportunity to receive continued mental healthcare in a safe environment, with services adapting to better suit people’s needs and lifestyles, such as parents not having to worry about arranging child care to continuing treatment12.

This was similarly identified in an Australian study in which patients concerned about contracting COVID-19 were able to undertake telehealth consultations rather than face-to-face13. Text, virtual supports and digital applications also play an important role given their availability and scalability, and these modalities increase people’s access to help while still allowing individuals to maintain a level of anonymity.

Besides the use of telehealth to deliver therapeutic interventions, it can also be used to provide support to individuals who might not be engaged in therapeutic care. This includes web chat and SMS services that allow people to speak to a trained mental health professional, as well as online forums where individuals can share experiences or seek support from their peers. While there are distinct advantages to social media (e.g. normalising help-seeking behaviour, raising awareness and creating and maintaining relationships) there are also disadvantages (e.g. cyber bullying, anti-social behaviour and the dissemination of fake news). To ensure the benefits are maximised it is important that social media supports are available for the right reasons and in the right forums. 

Previous research14 has identified a number of challenges and advantages associated with the use of telehealth in mental health service delivery. Challenges include:

  • barriers to widespread adoption including longstanding policies concerning reimbursement
  • privacy and safety concerns
  • lack of access to fast internet or adequate hardware
  • practical issues faced by hospitals, clinics, and providers still unprepared to deliver care through this modality.

However, a number of these barriers have already started to be mitigated due to changes instituted during the pandemic. There are also numerous advantages associated with the use of telehealth, including:

  • increasing access to mental health services for rural and remote communities
  • providing more flexibility in the way that mental healthcare is delivered
  • increasing continuity of care
  • addressing issues such as the lack of transportation and the ability to access specialist mental health services without having to travel long distances.

Opportunities for the future

Telehealth services can broaden the accessibility, availability and awareness of support available to the community. Future opportunities include:

  • building integrated service models that include a range of face-to-face and telehealth options,
  • growing different types of telehealth such as text messaging or social media-based support to extend access and awareness of services available,
  • delivering a broad range of service options, across the continuum of care, to those previously unable to access specialist care such as those living in rural and remote areas,
  • further understanding barriers to access mental healthcare (through in-person or virtual means) and identify mechanisms to overcome them,
  • embedding widespread mental wellbeing practices in mainstream channels, e.g. through social media, to further reduced stigma and raise awareness of available support.

Increasing the adoption of digitally-enabled care will make the mental health system more efficient and free up resources for individuals who require more intensive clinical care. As we emerge from COVID-19, it is important that we retain the advances made in access, awareness and availability of mental health services.

Sources

  1. Brooks, S. K., et al. (2020), The psychological impact of quarantine and how to reduce it: rapid review of the evidence, Lancet, 395, pp. 912-20
  2. ABC News, Mental health and COVID-19 – how the coronavirus is affecting our way of life, April 2020
  3. Beyond Blue, Beyond Blue welcomes funding for new COVID-19 support service, Accessed 19 June 2020
  4. ABC News, Lifeline needs more volunteers as calls for support hit record levels, May 2020
  5. SBS News, Coronavirus worries have Australian children calling Kids Helpline every 69 seconds, Accessed 19 June 2020
  6. ABC News, Mental health services are seeing a drop in usage amid coronavirus, despite increased anxiety, Accessed 29 June 2020
  7. Washington Post, Instagram public awareness campaign aims for real talk about mental health, Accessed 3 July 2020
  8. University of Queensland, Developing a policy strategy for telehealth in Australia: a summary of the telehealth FUTURES forum, November 2019
  9. Sammons, M.T. (2020), Psychological Practice and the COVID-19 Crisis: A Rapid Response Survey, May 2020
  10. Corruble, E. (2020), A viewpoint from Paris on the COVID-19 pandemic: A necessary turn to telepsychiatryJournal of Clinical Psychiatry
  11. Yellowlees, P., et al. (2020), Rapid Conversion of an Outpatient Psychiatric Clinic. Psychiatry Services in Advance, May 2020
  12. Sullivan, A.B. (2020), The COVID-19 Crisis: A Mental Health Perspective and Response using Telemedicine, Journal of Patient Experience, May 2020
  13. Kavoor, A. R., et al (2020), Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health setting. Asian Journal of Psychiatry, June 2020
  14. Cowan, K.E., et al. (2019), Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clinic Proceedings, December 2019