Environmental Factors for Sustained Telehealth Use in Mental Health Services: A Mixed Methods Analysis

Abstract

Background: The mental health service delivery gap remains high globally. Appropriate telehealth use may increase capacity through flexible remote care provision. Despite the historical lack of telehealth integration into publicly funded mental health services, during COVID-19 lockdowns, services rapidly switched to telephone and audiovisual care provision. In Aotearoa New Zealand (NZ), this was abandoned when no longer required by COVID-19 restrictions. This study explores environmental factors associated with telehealth implementation and ongoing use or discontinuation across a multiregional outpatient mental health service. This work contributes to understanding system-level factors influencing telehealth use and thus informs policy and practice in postpandemic environments. Methods: This mixed methods study applied an interpretive description methodology. Semistructured interviews with 33 mental health clinicians were thematically analysed. Qualitative findings were reframed and evaluated using time series analyses of population-level quantitative data (prior to and throughout the pandemic). Findings were synthesised with qualitative themes to develop an understanding of environmental factors contributing to telehealth use. Results: Findings highlighted an increase in clients assessed by mental health services and declining clinician numbers, contributing to pressure placed on clinicians. There was a lack of culture supporting telehealth, including limited awareness, leadership, and champions to facilitate implementation. Some teams provided services suited to telehealth; other subspeciality teams had limited applications for telehealth. There was a general lack of policy and guidelines to support telehealth use and limited technical support for clinicians unfamiliar with audiovisual software. Conclusion: Disorganised telehealth adoption in the study regions provides insight into wider environmental drivers affecting telehealth uptake. For telehealth to become a workable service delivery mode following COVID-19, stewardship and culture shifts are required, including policy development, technical support, and resources to support clinical teams. Telehealth may address growing service demand by improving interfaces with primary care and providing timely access to specialist input.

Keywords: clinician; interpretive description; mental health services; mixed methods research; telehealth.

Figure 1

Methods overview.

Figure 2

Activity flow for mental health services.

Figure 3

Analysis of key trends.

Figure 4

Service delivery by mode. AV = audiovisual, IP = in-person, Phone = telephone. December–January drop in referral numbers due to Christmas/New Year public holidays.

Figure 5

Clients receiving outpatient mental health treatment.

Figure 6

New referrals to outpatient mental health services. December–January drop in referral numbers due to Christmas/New Year public holidays.

Figure 7

Weekly average of practicing clinicians by role. Dr = doctor, Nur = nurse, OT = occupational therapist, SW = social worker, Thrpst = therapist. Drop in clinician numbers over December–January due to Christmas/New Year public holiday leave.

Figure 8

Weekly activities by type of attendance. Client = contact with client, C&F = client and family contact, Family = family only contact, Group = group activity. Drop in December–January attendance due to Christmas/New Year public holidays.

Figure 9

Average activity duration.

Figure 10

Audiovisual use by subspeciality. ACMHT = adult community mental health teams, CADS = community alcohol and drug services, CAMHS = child and adolescent mental health services, CRS = crisis resolution service, Māori = Māori mental health services (child and adult), OPMHS = older person mental health services.

Figure 11

Telephone use by subspeciality. ACMHT = adult community mental health teams, CADS = community alcohol and drug services, CAMHS = child and adolescent mental health services, CRS = crisis resolution service, Māori = Māori mental health services (child and adult), OPMHS = older person mental health services.