Telehealth service delivery in an Australian regional mental health service during COVID-19: a mixed methods analysis.

BACKGROUND: COVID-19 required mental health services to quickly switch from face-to-face service delivery to telehealth (telephone and videoconferencing). This evaluation explored implementation of a telehealth mental health response in a regional public mental health provider. METHODS: A mixed methods approach, combining service use data, brief satisfaction surveys, and qualitative interviews/focus groups was undertaken. Number and types of contacts from de-identified mental health service data were compared between April-May 2020 and April-May 2019. Mental health consumers and providers completed brief online satisfaction surveys after videoconferencing sessions. Attitudes and perspectives on the implementation of telehealth were further explored by applying a descriptive qualitative framework to the analysis of interview and focus group data supplied by consumers and providers. Template thematic analysis was used to elucidate key themes relating to the barriers and enablers of telehealth uptake and future implementation recommendations. RESULTS: Total contacts decreased by 13% from 2019 to 2020. Face-to-face contacts decreased from 55% of total in 2019 to 24% in 2020. In 2019, 45% of contacts were by telephone, increasing to 70% in 2020. Only four videoconferencing contacts were made in 2019; increasing to 886 in 2020. Consumer surveys (n = 26) rated videoconferencing as good or excellent for technical quality (92%), overall experience (86%), and satisfaction with personal comfort (82%). Provider surveys (n = 88) rated technical quality as good or excellent (68%) and 86% could achieve assessment/treatment goals with videoconferencing. Provider focus groups/interviews (n = 32) identified that videoconferencing was well-suited to some clinical tasks. Consumers interviewed (n = 6) endorsed the ongoing availability of telehealth within a blended approach to service delivery. Both groups reflected on videoconferencing limitations due to infrastructure (laptops, phones, internet access), cumbersome platform and privacy concerns, with many reverting to telephone use. CONCLUSIONS: While videoconferencing increased, technical and other issues led to telephone being the preferred contact method. Satisfaction surveys indicated improvement opportunities in videoconferencing. Investment in user-friendly platforms, telehealth infrastructure and organisational guidelines are needed for successful integration of videoconferencing in public mental health systems.

Assessing mental health literacy of primary health care workers in Kenya: a cross-sectional survey.

AIM: To assess mental health literacy of health workers in primary health care services in Kenya. BACKGROUND: Mental illness is common in Kenya, yet there are fewer than 500 specialist mental health workers to serve Kenya's population of over 50 million. The World Health Organization recommends the integration of mental health care into primary health care services to improve access to and equity of this care, especially in low and middle-income countries. An important step to integrating mental health care into primary health care services is to determine mental health literacy levels of the primary health care workforce. METHOD: A cross-sectional survey using Jorm's Mental Health Literacy Instrument (adapted for the Kenyan context) was administered to 310 primary health care workers in four counties of Kenya. RESULTS: Of the 310 questionnaires distributed, 212 (68.3%) were returned. Of the respondents, 13% had a formal mental health qualification, while only 8.7% had received relevant continuing professional development in the five years preceding the survey. Just over one third (35.6%) of primary health care workers could correctly identify depression, with even fewer recognising schizophrenia (15.7%). CONCLUSIONS: This study provides preliminary information about mental health literacy among primary health care workers in Kenya. The majority of respondents had low mental health literacy as indicated by their inability to identify common mental disorders. While identifying gaps in primary health care workers' mental health knowledge, these data highlight opportunities for capacity building that can enhance mental health care in Kenya and similar low and middle-income countries.

Mental healthcare in Kenya: exploring optimal conditions for capacity building.

The global burden of disease related to mental disorders is on the increase, with the World Health Organization (WHO) estimating that over 450 million people are affected worldwide. The Mental Health Global Action Program (mhGAP) was launched by the WHO in 2002 in order to address the widening gap in access to mental healthcare in low-income countries. Despite these efforts, access to mental healthcare in low-income countries remains poor and is often described as inadequate, inefficient and inequitable, with an 85% estimated treatment gap in low-income countries, as compared with 35% to 50% in high-income countries.In this article, the authors argue that integrating mental health services into primary healthcare settings through capacity building is vital with regard to achieving mhGAP goals. The article explores the challenges to and potential enablers for the improvement of the delivery of broad-based mental healthcare services in Kenya. The authors propose the integration of the conceptual dimensions of both the cosmopolitanism and capabilities approaches as a combined strategy for dealing with capacity building in heterogeneous settings such as Kenya.

Mental health telephone triage: managing psychiatric crisis and emergency.

PURPOSE: The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone. DESIGN AND METHODS: An observational design was employed in the study. Wireless headsets were used to observe 197 occasions of MHTT. FINDINGS: Clinicians use a range of practical strategies, therapeutic skills, and psychosocial interventions to manage psychiatric crises and emergencies via the telephone. PRACTICE IMPLICATIONS: The evidence base for managing psychiatric crisis/emergency in MHTT is minimal. These findings contribute to the MHTT knowledge base and provide evidence-based strategies for high-quality emergency mental health care.