Engagement challenges in digital mental health programs: hybrid approaches and user retention of an online self-knowledge journey in Brazil.

Digital mental health interventions (DMHIs) have surged in popularity over the last few years. However, adherence to self-guided interventions remains a major hurdle to overcome. The current study utilized a phased implementation design, incorporating diverse samples and contexts to delve into the engagement challenges faced by a recently launched online mental health platform in Brazil with self-evaluation forms. Employing an iterative mixed-methods approach, including focus groups, online surveys, and think-aloud protocols, the research aims to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions. Engagement in the platform was evaluated by descriptive statistics of the number of instruments completed, and qualitative interviews that were interpreted thematically. In the fully self-guided mode, 2,145 individuals registered, but a substantial majority (88.9%) engaged with the platform for only 1 day, and merely 3.3% completed all activities. In another sample of 50 participants were given a choice between online-only or a hybrid experience with face-to-face meetings. 40% of individuals from the hybrid group completed all activities, compared to 8% in the online-only format. Time constraints emerged as a significant barrier to engagement, with suggested improvements including app development, periodic reminders, and meetings with healthcare professionals. While the study identified weaknesses in the number and length of instruments, personalized results stood out as a major strength. Overall, the findings indicate high satisfaction with the mental health platform but underscore the need for improvements, emphasizing the promise of personalized mental health information and acknowledging persistent barriers in a digital-only setting.

Telepsychiatry in the Treatment of Major Depressive Disorders.

This chapter explores the transformative role of telepsychiatry in managing major depressive disorders (MDD). Traversing geographical barriers and reducing stigma, this innovative branch of telemedicine leverages digital platforms to deliver effective psychiatric care. We investigate the evolution of telepsychiatry, examining its diverse interventions such as videoconferencing-based psychotherapy, medication management, and mobile applications. While offering significant advantages like increased accessibility, cost-effectiveness, and improved patient engagement, challenges in telepsychiatry include technological barriers, privacy concerns, ethical and legal considerations, and digital literacy gaps. Looking forward, emerging technologies like virtual reality, artificial intelligence, and precision medicine hold immense potential to personalize and enhance treatment effectiveness. Recognizing its limitations and advocating for equitable access, this chapter underscores telepsychiatry's power to revolutionize MDD treatment, making quality mental healthcare a reality for all.

Bridging the mental health gap: The scope, challenges, and future of digital psychiatry in India.

The mental health burden in India is increasing at unprecedented rates. The increased demand for mental health care and the undersupply of services has widened the treatment gap. Due to several factors, such as increasing service costs and the circumstances surrounding the COVID-19 pandemic, India has witnessed an inclination toward using digital mental health solutions to overcome the treatment gap. Drawing from the collective evidence and experience in implementing mental health solutions using digital phenotyping and smartphone app-based care delivery in India, we define the scope, potential, and challenges of implementing synchronous and asynchronous digital mental health solutions that can serve as a template for improving global mental health.

Client perspectives: Telehealth for mental health services.

OBJECTIVE: The COVID-19 pandemic required mental health clinicians globally to transition to the delivery of care via telehealth. This study aimed to gain an understanding of clients' satisfaction with and attitudes towards telehealth mental health services. METHOD: Seventy adults who had attended a clinic for mood and anxiety disorders, and participated in at least one telehealth consultation with a psychologist or psychiatrist, completed an anonymous online survey. RESULTS: The majority of participants (81.5%) reported satisfaction with telehealth mental health care provided during the COVID-19 pandemic. However, satisfaction overall was significantly higher amongst participants who had received both telehealth and face-to-face mental health care, compared to participants who received care via telehealth only. Advantages of telehealth care reported included convenience and increased access to mental health clinicians. However, disadvantages of telehealth care included greater difficulty developing a rapport with a clinician and expressing oneself via telehealth. CONCLUSIONS: Whilst client satisfaction with telehealth mental health care for mood and anxiety disorders is generally high, clinicians should consider the limitations of telehealth from clients' perspectives. In particular, strategies to enhance therapeutic connection during telehealth sessions may be needed, and client preferences for mode of delivery should be taken into consideration when possible.

Capturing Patients' and Clinicians' Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis.

BACKGROUND: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. OBJECTIVE: The aim of this study was to investigate patients' and clinicians' experiences and attitudes toward using VCs in clinical practice. METHODS: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. RESULTS: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians' experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. CONCLUSIONS: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients' and clinicians' perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions.

Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: A retrospective study.

OBJECTIVE: The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation. METHODS: Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots. RESULTS: Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services. CONCLUSIONS: MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry.

Telepsychiatry Current Practice and Implications for Future Trends: A 2023 American Psychiatric Association Member Survey.

Introduction: Although telehealth was a viable means of delivering psychiatric care even before the COVID-19 public health emergency, flexibilities at the federal and state levels during the pandemic prompted mass adoption in a short timeframe. Little is known about how psychiatrists plan to offer care going forward and to what degree services will be offered virtually, in-person, or in a hybrid format. Methods: We conducted a survey of American Psychiatric Association (APA) members regarding telepsychiatry practice and potential barriers. Results: The survey was completed by 1,660 APA members. Most survey respondents (94%) conduct at least some telepsychiatry. Most respondents indicate operating in a hybrid environment in which they maintain a physical practice location, while 16% indicate that they do not have a physical practice and only see patients remotely. Across all setting types, 82% of respondents deliver telehealth via all or mostly video; 11% report conducting telehealth visits via mostly audio-only modalities; and 7% report equal usage of both modalities. Barriers to telepsychiatry noted by respondents include limited reimbursement, state medical licensure, federal and state regulations regarding controlled substance prescribing via telehealth, and technical challenges. Conclusion: Results of this survey of APA members show that the majority conduct at least some telepsychiatry; operate in a hybrid environment; and deliver telehealth via all or mostly video. Reported barriers to telepsychiatry practice include legal, regulatory, reimbursement, and technical issues. The future of telepsychiatry may largely be determined by which legal, regulatory, and reimbursement flexibilities are ended, extended temporarily, or made permanent.

Developing a brief telematic cognitive behavioral therapy for the treatment of social isolation in young adults.

Objective: The present study aims to present a novel cognitive-behavioral intervention protocol focused on treating social isolation through telematic interaction, thus overcoming common barriers characteristic of face-to-face interventions. Methods: We examined current literature about face-to-face and telematic psychotherapeutic interventions for the treatment of social isolation in early adulthood. Current evidence is mixed, suggesting the need to develop novel interventions focused on patients' cognitive functioning. Moreover, telematic interventions are promising candidates for overcoming common barriers intrinsic to the condition of social isolation. Results: The present 8-session model inspired by cognitive behavioral theoretical models and cognitive interventions currently present in the literature is thought to help socially isolated adult patients reduce clinical symptoms associated with the condition and lead to a reduction in the avoidance of social situations, leading to an improvement of the quality of life. Conclusion: We presented a telematic psychotherapeutic intervention aimed at helping adult patients suffering from social isolation who are unable to seek help from national health systems and face-to-face interventions, thus overcoming barriers intrinsic to social isolation. The present cognitive-behavioral treatment protocol has been developed in the context of a randomized clinical trial ongoing in Italy, aimed at implementing and testing the feasibility and effectiveness of multimodal digital interventions for treating social isolation.

The potentiality of telepsychiatry using a teleoperated robot for a patient with alcohol abuse on an isolated island.

Background: Providing medical care on isolated islands can be challenging in several ways. Telepsychiatry can potentially offer a solution for accessible psychiatric services on isolated islands. When video conferencing is used in telepsychiatry, the psychiatry specialist, who is remotely located, may find it difficult to establish trust. To address this, we developed a teleoperated robot system termed "Sota 100," which is equipped to convey various elements of nonverbal communication, such as eye contact, in remote settings. Case Presentation: In this report, we introduce the case of a patient with alcohol use disorder who lived on an isolated island and received medical care from a primary care physician at the island's medical clinic and from Sota 100 teleoperated by a psychiatry specialist. Using this system, the patient admitted that he had developed a physical illness and had damaged his relationships partly because of alcohol abuse. At the conclusion of the three-way conversation, the patient understood that stopping drinking alcohol was the only way to prevent worsening his physical condition and damaging his relationships further. Concurrently, the primary care physician gained a deeper understanding of the etiology of alcohol use disorder and of how to support patients with alcohol dependency. Conclusion: These case findings suggest that our system is helpful for patients with alcohol use disorder who need to receive telepsychiatry services. Future studies should include single-case experimental designs with regular measurements of key outcome variables and other relevant variables over time.

Innovative technology and mental health care. Survey on the usage of WhatsApp among Argentinian psychiatrists and psychologists / Nuevas tecnologías y atención en Salud Mental. Encuesta a psiquiatras y psicólogos de Argentina sobre el uso del WhatsApp.

OBJECTIVE: Communication between patients and mental health professionals by means of messaging platforms in the interval between synchronous encounters became a kind of asynchronous teleconsultation (AT) whose usefulness and effect on providers' workload have not been explored. Method: Mental health providers working in Argentina were invited to answer a survey exploring the intensity and usefulness of AT, and the resulting overload. RESULTS: A total of 527 responses from professionals working throughout the country were received. As much as 69% of respondents exchanged messages with a mean of 1-10 patients/day and 31% with more than 10 patients/day; 75% answered messages over mobile phones on weekends. While 68% rated these interactions as positive for clinical follow-up, 47% considered them as a source of work overload. CONCLUSIONS: The generalized adoption of AT may require additional self-regulation by clinicians and regular monitoring of overload levels (particularly, among psychiatrists) to make their daily clinical practice efficient and sustainable.

OBJETIVOS: La comunicación entre pacientes y profesionales de la salud mental mediante plataformas de mensa- jería en el intervalo entre encuentros presenciales o virtuales se convirtió en una modalidad de teleconsulta asincrónica (TA) cuya utilidad y efecto en la carga de trabajo de los profesionales de salud mental no se han explorado. Método: Profesionales del campo de la salud mental que trabajan en Argentina fueron invitados a responder a una encuesta que exploraba la intensidad y utilidad de la TA, y la sobrecarga resultante. RESULTADOS: Se recibieron un total de 527 respuestas de profesionales que trabajan en todo el país. El 69 % de los encuestados mensajes con un promedio de 1-10 pacientes/día y el 31 % con más de 10 pacientes/día; el 75 % respondió mensajes por teléfono móvil los fines de semana. Mientras que el 68 % calificó estas interacciones como positivas para  el seguimiento clínico, el 47 % las consideró una fuente de sobrecarga laboral. CONCLUSIONES: La adopción generalizada de la TA puede requerir una autorregulación adicional por parte de los profesionales y un seguimiento regular de los niveles de sobrecarga (especialmente, entre los psiquiatras) para que su práctica clínica diaria sea eficiente y sostenible.

Telepsychiatry for people with intellectual disabilities and mental health difficulties during Covid-19 pandemic: survey of self-reported experience and acceptability to patients, carers and psychiatrists in the UK.

Aim: This project sought to ascertain views and experiences of people with intellectual disabilities, their carers', and specialist intellectual disability psychiatrists as to use of telepsychiatry consultations. Background: During the Covid-19 pandemic specialist psychiatrists in intellectual disability services in the United Kingdom (UK) have explored and adopted use of telepsychiatry for psychiatric consultations. Method: An easy-read co-designed questionnaire was sent to potential respondents N = 590 potential respondents (N = 280 patients, N = 280 carers), and a separate questionnaire was sent electronically to N = 30 specialist intellectual disability psychiatrists. Findings: Responses were received from N = 192 respondents (N = 68 (24%) patients, N = 98 (35%) carers, and N = 26 (90%)) psychiatrists. Advantages of telepsychiatry cited were flexibility, and it being less disruptive to patients' routines, offering convenient practice and saving travel time and cost. Disadvantages reported included loss of rapport and relationship with patients, and an inability to conduct an effective mental state examination. Conclusion: This survey has produced equivocal evidence as to acceptability of telepsychiatry for all people with intellectual disabilities, carers and psychiatrists cannot be assumed. Some patients may need significant support to enable them to engage with such an approach.

The Use of Telepsychiatry Services in Emergency Settings: Scoping Review.

BACKGROUND: Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP's effectiveness in the ED setting, as well as the process of implementing TP in this setting. OBJECTIVE: This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. METHODS: The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. RESULTS: A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. CONCLUSIONS: Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP's effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.

Relationship Between Obesity and Intellectual/Developmental Disability in an Ohio Telepsychiatry Clinic: A Retrospective Review.

Co-occurring intellectual/developmental disability (IDD) and overweight/obesity (OW/OB) is an important consideration of IDD psychiatric care. The relationship between OW/OB and comorbid diagnoses of Autism Spectrum Disorder (ASD) and/or IDD remains inadequately described in existing literature. The purpose of this study is to explore these co-occurring diagnoses. Improved understanding of associated comorbidities can guide clinicians toward interventions to minimize complications associated with OW/OB. We conducted a retrospective review of adult patients of a telepsychiatry clinic with IDD or ASD defined by DSM-5. ICD-10 diagnosis of IDD or ASD, demographics, BMI, comorbidities, and current medications were recorded. Binary logistic regression was used to estimate associations between each predictor and the outcomes overweight (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2). Prevalence of obesity in these 412 adults was 52.4% (95% CI 47.5, 57.3). There was a significant inverse relationship between IDD severity and the odds of each outcome (p < .001). 80.3% of patients were being actively treated with an antidepressant. Patients taking an antidepressant had twice the odds of obesity (adjusted OR 2.03, 95% CI 1.23, 3.41, p = .006). These findings provide a sense of urgency for prevention of OW/OB and its associated medical sequelae. Prevalence of obesity was higher in this sample compared to the general population. The inverse relationship between IDD severity and OW/OB warrants further research examining age, caregiver involvement, and access to care as potential modifiers.

Education and training of telemental health providers: a systematic review.

Objective: To conduct a systematic literature review of education and training (E&T) programs for telemental health (TMH) providers in the past 10 years to qualitatively clarify field offerings and methodologies, as well as identify areas for future growth. Methods: We searched five major electronic databases: PubMed, PsycINFO, Scopus, CINAHL, and Web of Science for original publications on TMH E&T from January 2013 to May 2023. We extracted information from each publication and summarized key features of training programs including setting, target group, study aims, training modality, methods of assessing quality, and outcomes. Results: A total of 20 articles were selected for the final review. Articles meeting inclusionary criteria were predominantly comprised of case studies and commentaries, focused on a TMH service/practice for a specific region/population, and were performed after 2020. All of the selected studies demonstrated a significant increase in the measured knowledge, skills, and abilities of the participants after TMH training. Nevertheless, there remains a lack of standardization of training methodologies, limited sample sizes and demographics, variability in study methodologies, and inconsistency of competency targets across studies. Conclusion: This systematic review highlighted the diversity of methods for TMH E&T. Future research on this topic could include more varied and larger-scale studies to further validate and extend current findings, as well as explore potential long-term effects of TMH training programs on both provider attitudes and patient outcomes.

Patients' experiences with tele-mental health services during COVID-19 in Pakistan.

Background: Although the concept of telehealth is of great interest globally, its potential has not yet been realized in Pakistan. It is therefore essential to explore the perspectives of stakeholders on the technology, particularly for mental health, to be able to increase and improve its use. Aim: To assess the perceptions and experiences of patients receiving tele-mental health services, including telepsychiatry and tele-psychotherapy, in Pakistan. Methods: For this qualitative exploratory study, we conducted in-depth interviews with 49 individuals at a tertiary care hospital in Karachi, Pakistan. Using the Cresswell framework for content analysis, we identified 3 major themes that focused on the positive and negative aspects of tele-mental health services and made suggestions for enhancing them. Results: Twenty-six of the participants received telepsychiatry, while the remaining 23 received tele-psychotherapy services. Technical literacy, cost of consultation, privacy, and therapeutic alliance were the major challenges identified by the patients, while convenience and the absence of stigma were highlighted as key facilitators for tele-mental health. Tele-consultations reduced travel and waiting time, thus improving access to healthcare. Participants suggested that the processes for booking appointments and making payments should be streamlined and the cost of tele-consultation reduced. Conclusion: This study provides insightful findings on tele-mental health services from the perspectives of patients living in an Asian culture. The major benefits highlighted were destigmatization of mental health and elimination of commuting costs and travel time. There were concerns about privacy, therapeutic alliance and availability and affordability of the technology.

The relationship between therapeutic alliance, frequency of consultation and uptake of telemedicine among patients seeking treatment for early psychosis: A moderated mediation model.

Background: Telehealth services ensure the delivery of healthcare services to a wider range of consumers through online platforms. Nonetheless, the acceptance and uptake of telehealth remain elusive. This study aims to understand the (a) uptake and (b) acceptability of telemedicine, (c) if therapeutic alliance mediates the relationship between the frequency of consultations with clinicians and the uptake of telemedicine in patients with early psychosis, and (d) role of education in moderating the relationship between therapeutic alliance and the uptake of telemedicine for their mental healthcare. Methods: A convenience sample of outpatients (n = 109) seeking treatment for early psychosis and their care providers (n = 106) were recruited from a tertiary psychiatric care centre. Sociodemographic and clinical characteristics, therapeutic alliance (Working Alliance Inventory), and telemedicine use were captured through self-administered surveys. The moderated mediation analysis was performed using PROCESS macro 3.4.1 with therapeutic alliance and level of education as the mediating and moderating factors, respectively. Results: The acceptance of telemedicine was high (possibly will use: 47.7%; definitely will use: 26.6%) whilst the uptake was low (11%). Therapeutic alliance mediated the relationship between the frequency of consultation and the uptake of telemedicine (ß: 0.326; CI: 0.042, 0.637). This effect was moderated by the level of education (ß: -0.058; p < 0.05). Conclusion: Therapeutic alliance mediates the relationship between the frequency of consultations and the uptake of telemedicine services with the level of education moderating this mediation. Focusing on the patients with lower education to improve their telemedicine knowledge and therapeutic alliance might increase the uptake.

Prisoners' Perceptions and Satisfaction with Telepsychiatry Services in Greece and the Effects of Its Use on the Coercion of Mental Healthcare.

BACKGROUND: Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). METHOD: The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. RESULTS: Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). CONCLUSION: According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices.

Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey.

Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.

Staff experiences with videoconferences during the COVID-19 pandemic in forensic psychiatry outpatients.

AIM: To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. METHOD: Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. RESULTS: Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact-pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? CONCLUSION: Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences.