Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK.
The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
BMC Psychiatry. 2023 Sep 2;23(1):641. doi: 10.1186/s12888-023-05126-8.
During the COVID-19 pandemic, technologies such as videoconferencing were used to deliver mental health appointments remotely online. For many people, this was a change from previous methods of mental healthcare receipt and delivery. We aimed to explore in-depth how practitioners, young people and parents in the UK experienced this transition.
We used qualitative methods to collect data, triangulating between free-text online survey data (n = 38), focus groups (n = 5) (3 young adult groups (total n = 11); 2 practitioner groups (total n = 7)), and semi-structured interviews (practitioners n = 8; parents n = 4). Data were analysed using reflexive thematic analysis.
Participants held mixed views about remote appointments, which were encompassed within the five themes of: home as clinic; disrupted therapeutic relationships; difficulties with engagement; uncontained risk; and scope of care provision. While appointments at home could be regarded as more comfortable, naturalistic and accessible, it was also recognised that remoteness compromised practitioner control with consequences for their ability to monitor patient engagement, manage risk and ensure confidentiality when others were present in the home. This could create an additional burden for parents as they tried to facilitate appointments but felt unsupported in this role. Relatedly, remoteness was seen to hinder interpersonal communication, formation of trust, communication of empathy and opportunities to observe body language, all of which were deemed important to building and maintaining effective therapeutic relationships. Despite this, others thought the anonymity of a remote exchange may allow earlier disclosure. There was disagreement as to whether remote provision narrowed or expanded the scope of practice.
While some had positive views of remote mental health appointments, others found them challenging. Findings highlight key areas requiring attention and mitigation in future offerings of remote provision, namely: risk management, parental burden, and problematic engagement.
在 COVID-19 大流行期间，视频会议等技术被用于远程在线提供心理健康预约服务。对于许多人来说，这是对以前接受和提供心理健康服务方式的改变。我们旨在深入探讨英国的从业者、年轻人和家长是如何体验这种转变的。
我们使用定性方法收集数据，通过自由文本在线调查数据（n=38）、焦点小组（n=5）（3 个青年组（共 n=11）；2 个从业者组（共 n=7））和半结构化访谈（从业者 n=8；家长 n=4）进行三角测量。数据采用反思性主题分析进行分析。
参与者对远程预约持有不同的看法，这些看法包含在以下五个主题中：家庭诊所；治疗关系中断；参与困难；不可控风险；和护理范围。虽然在家中进行预约可能被认为更舒适、自然和方便，但也认识到远程会损害从业者的控制能力，从而影响他们监测患者参与度、管理风险以及在他人在场时确保保密性的能力。这可能会给试图协助预约但感到不受支持的家长带来额外的负担。相关地，远程被认为会阻碍人际沟通、信任的建立、同理心的传达和观察肢体语言的机会，所有这些都被认为对建立和维持有效的治疗关系很重要。尽管如此，也有人认为远程交流的匿名性可能会促使更早的披露。对于远程服务是缩小还是扩大实践范围存在分歧。
虽然有些人对远程心理健康预约持积极看法，但也有人认为它们具有挑战性。研究结果强调了未来远程服务提供中需要关注和缓解的关键领域，即：风险管理、家长负担和参与问题。
