Face-to-face or remote consultations for people with mental illness in secondary mental health care
Dr Mariana Pinto Da Costa
Senior Lecturer, Consultant Psychiatrist
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN)
King’s College London
Prof Fiona Gaughran, Prof Robert Stewart
The number of people with mental disorders has increased (McManus S, 2016), but access to treatment is still scarce, with studies suggesting that about one third of the people with mental health disorders receive appropriate treatment (Evans Lacko S et al, 2018). Remote consultations, using telephone and internet-based resources, are promising approaches to reduce the mental health treatment gap, especially in rural regions or in settings where mental health care is limited (Hoeft TJ et al, 2018).
Tele-health is a core component of the UK mental health care in the NHS 5-year plan. A recent umbrella review of systematic reviews on the evidence-based guidance on tele mental health reported that, whilst the findings suggest that video-based communication could be as effective and acceptable as face-to-face contacts, the extent of digital exclusion and how it can be overcome was found to be lacking (Barnett P et al 2021). In England, a study of patients’ experiences with remote mental health services reported mixed results (Liberati E, et al, 2021). On one hand, patients valued the possibility of maintaining contact with their clinicians instead of scheduling appointments with new staff. On the other hand, they highlighted limitations in the therapeutic relationship due to the lack of non-verbal cues and technical training, and the exclusion of certain services that were not implementing remote care. Bonding is a key element of the therapeutic relationship, particularly important for people with mental health disorders.
During the pandemic the implementation of technology in mental health care was rapidly accelerated, and a recent systematic review has investigated the implementation, adoption and perceptions of tele mental health, suggesting good acceptability to patients and clinicians (Appleton R et al 2021). However, there has been so far no investigation and comparison of the use of remote consultations in secondary mental health services across London and outside; and whether these modalities have an impact in patients’ outcomes.
What are the differences between providing consultations remotely and in-person in patients’ outcomes in secondary mental health services?
This PhD project will aim to investigate differences in the two consultation modalities (face-to-face and remote) including the patterns of health care use (e.g. attended and non-attended [‘DNA’] appointments, planned and unplanned appointments, duration of appointments) pre- and post-pandemic, and their personal and service impact.
A series of analyses of datasets covering North and South London (DISCOVER-NOW and CRIS) and the East of England (CRATE) comparing face-to-face and remote consultations in secondary mental health care services will be conducted by the student. The analysis will describe for each dataset, the variables relating to secondary mental health care activity.
Individual interviews will be conducted by the student with clinicians and patients in secondary mental health care covering the North and South London areas, and the East of England. This will allow the exploration of views on preferences for the mode of delivery of care and possible issues associated with remote care access in different geographical regions.
This project will provide a broad range of training opportunities in: i) data curation, the management of big data, statistical skills and data analysis; ii) recruitment of study participants and qualitative skills of conducting in-depth interviews and thematic analysis. Additional training in general PhD skills such as communication and writing academic papers will be available through the Centre for Doctoral Studies at King’s College London (KCL).
The student will work closely with the supervisors to design the studies and interpret the results. Throughout the PhD project the student will be supported by the supervisors in disseminating their work and publishing it in high impact scientific journals and in national and international meetings.
Theme: Learning from Big Data for Health Knowledge
Data analyses using the CRIS resource are covered through an existing approval for its use in research (Oxford REC C, reference 18/SC/0372). Access to the Discover-NOW dataset requires application to the North-West London Data Access Group, which has a turnaround time of up to 4 weeks. Access to CRATE requires application to the Cambridgeshire and Petersborough NHS Foundation Trust (CPFT). South London and Maudsley NHS Foundation Trust (SLaM) and CPFT are collaborating successfully in other initiatives, such as the DATAMIND HDR-UK Mental Health Hub.
Tele-health, mental healthcare, health service research, big data, data linkage, mixed methods, digital exclusion