Environmental Factors for Sustained Telehealth Use in Mental Health Services: A Mixed Methods Analysis

Area of Science:

• Public Health
• Mental Health Services Research
• Health Informatics

Background:

• Global mental health service delivery gaps persist, exacerbated by increasing client numbers and declining clinician numbers.
• The COVID-19 pandemic accelerated the adoption of telehealth (remote care) in mental health services, but this was often abandoned post-restrictions.
• Understanding environmental factors influencing telehealth implementation and sustainability is crucial for post-pandemic healthcare policy.

Purpose of the Study:

• To explore environmental factors influencing the implementation and ongoing use or discontinuation of telehealth in a multiregional outpatient mental health service in Aotearoa New Zealand.
• To identify system-level barriers and facilitators impacting telehealth adoption within publicly funded mental health settings.
• To inform future policy and practice for effective telehealth integration in mental health care.

Main Methods:

• A mixed-methods approach using interpretive description methodology.
• Thematic analysis of semistructured interviews with 33 mental health clinicians.
• Time series analysis of population-level quantitative data, synthesized with qualitative findings.

Main Results:

• Increased client assessments and declining clinician numbers created significant pressure on mental health professionals.
• A lack of supportive telehealth culture, including limited awareness, leadership, and champions, hindered implementation.
• Inconsistent applicability of telehealth across different subspecialty teams, coupled with a lack of policy, guidelines, and technical support, presented challenges.

Conclusions:

• Disorganized telehealth adoption highlights systemic environmental drivers affecting uptake, necessitating cultural shifts and improved stewardship.
• Sustainable telehealth integration requires policy development, robust technical support, and dedicated resources for clinical teams.
• Telehealth holds potential to address growing mental health service demand by enhancing primary care interfaces and specialist access.