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Use of video consultation in mental health departments in a hospital: a qualitative study of therapists' experiences of video consultations during the period of Covid-19 restrictions.

BACKGROUND
As part of the political and professional development and increased focus on including service users within mental health services, services are being transformed: specifically, they are shifting from institutional to non-institutional care provision and increasingly integrating the use of e-health and digitalization. In the period from March to May 2020, Covid-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy.


OBJECTIVE
The aim of this paper is to develop and advance comprehensive knowledge about how therapists experience the use of VC. In order to reach this objective we draw on a study of therapists' experiences using video consultation (VC) in specialized mental health services in the early phase of the Covid-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of the Covid-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work?


METHODS
This study employed a qualitative approach, based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during Covid-19 restrictions.


RESULTS
Therapists included in this study experienced advantages using VC in circumstances that did not permit face-to-face consultations. The continuity that video consultations offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment, such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC, lowered the therapists' overall impression of the service. The themes that arose in the analysis of the data have been categorized in the following main topics: 1) VC-'it's better than nothing'; 2) VC affects therapists' work situation-opportunities and challenges in working conditions; 3) VC represents challenges when performing professional assessment and therapy on the screen.


CONCLUSIONS
Experiences with video consultations in a mental health hospital during Covid-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists' overall impression of VC. Further qualitative research is needed, and future studies should focus on service users' experiences, co-creation between different stakeholders and how to scale up the use of VC while ensuring that the service provided is appropriate, safe and available.


CLINICALTRIAL