Improving Outpatient Mental Health Service Delivery via Informed Use of Telehealth in New Zealand: A Mixed Methods Interpretive Description Study of Clinician Perspectives and Administrative Data

Background: Telehealth offers opportunities for increasing or improving mental health service delivery but, despite significant research around its efficacy, also brings challenges and risks. The COVID-19 pandemic changed health service delivery to meet population needs while minimising virus transmission. In many countries, mental health services rapidly shifted to using telehealth in largely unprecedented ways. This shift provided unique opportunities for understanding how telehealth was implemented and used to provide services. When considering the implementation of telehealth within mental health services, there is a dearth of studies examining implementation across multiple service providers. This means that the current understanding of clinician experience, barriers and facilitators, and recommendations around the future use of telehealth are largely built on single-site studies. This research examines the use of telehealth in outpatient mental health services during and following the COVID-19 pandemic across three regions in Aotearoa New Zealand. In so doing, this work informs consideration about the future implementation and use of telehealth in mental health services.

Method: An interpretive description methodology guides this mixed methods research. Thirty-three clinicians working in outpatient mental health teams who used telehealth during the pandemic participated in semi-structured one-to-one interviews. Interviews were transcribed and analysed using reflexive thematic analysis. Alongside this, quantitative administrative data of outpatient team clinical activities in the study regions was sourced and analysed to understand trends in telehealth use based on clinician specialisations, outpatient team, and across different periods (before the COVID-19 pandemic, during social distancing, and after each instance of the pandemic when social distancing measures were loosened).

Results: The results of this study are presented in three peer-reviewed publications. Major findings highlight the complexity inherent in implementing telehealth during a pandemic and emphasise challenges in continuing to operationalise this tool as part of usual business. Clinicians spoke at length about the need to provide flexibility and enable choice. However, clinicians also described personal and professional experiences that influenced their pandemic journeys, including the struggle to adapt to working from home while maintaining wellbeing and managing communication issues. Clinicians also described the impact experience, training, cultural, leadership, and organisational barriers had on the implementation and use of telehealth. Administrative activity data emphasised the increasing demand for mental health services and declining clinician numbers but also showed underlying differences between the type of telehealth service (telephone or audiovisual), outpatient teams, and client populations.

Discussion and conclusion: This research provides original insights into clinicians’ experiences delivering outpatient mental health care via telehealth. Recommendations arising from this work support clinician wellbeing, clinical activities, and telehealth implementation. A first step in working towards these recommendations to support telehealth could include further telehealth-specific education and training for clinicians. Such work is timely given (1) the ongoing effects of COVID-19 on mental health services; (2) the possibility of digital exclusion being exacerbated by a poorly designed telehealth system; (3) the effect of telehealth on the mental health workforce; and (4) service provision changes brought about through the Aotearoa New Zealand health system reform. Methodologically, this work provides further evidence of the potential for interpretive description research to be applied to mixed methods studies.