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