Table 2 Changes identified in mental health services table

Care delivery via technology

Service provision via technology was largely seen as a viable alternative to in-person mental health services. Here remote service provision was seen as a viable alternative to face-to-face care delivery

1. Such factors as efficiency in clinic’s work [40] clarity in service provision [45], speed of information delivery, real-time observations of patients’ home environment [58, 61], cost reduction were sent as factors supporting the use of remote service delivery. 2. Despite the mentioned technology advantages such as flexibility, accessibility and mobility of care providers, six studies highlighted that technology also meant that work became more isolated, and establishment of informal working relationships was difficult [32, 42, 44, 58,59,60]. 3. For those who did not know the patients well before the lockdown restrictions, building a good rapport with patients was challenging and sometimes impossible [31, 42, 58]

Accessibility to services

Accessibility of services means the ability of patients to receive medical care and engage with care providers when needed

1. Remote support was provided for those who resided in communal group accommodation (current and ex-substance users) which was a barrier for individuals to have enough space and place during remote meetings [32]. 2. Text messages were sent to patients which increased service users’ ability to receive medical care and information [33] 3. Laptops were provided to patients prior to treatment to ensure accessibility. Also, local police had contact details of patients to increase access to emergency services. [46] 4. Where the mental health services were provided in a closed unit due to COVID, it allowed patients to have uninterrupted treatment which was appreciated by patients [41]. 5. It was also reported that nursing care providers saw technology as a barrier to delivering effective care which also hindered the progress of care [52]

Flexibility of services

Flexibility of services included adaptability of services according to external conditions/factors and to the needs of patients and service providers

1. Patients were offered a variety of ways for feedback and guidance including informational orientation sessions before therapy; diary keeping; brief feedback sessions with specialists [37] 2. When providing services to homeless population flexibility negatively impacted patients as they felt that they lost control of the help available, did not have any structure to support provision and lacked options to access it [32] 3. The flexibility was also reported as a negative aspect of change as it “may have also diminished the sanctity of treatment” which led to low attendance rates. [35] 3. During the pandemic people felt they lost control of their circumstances and were frustrated with being offered limited and no flexibility in options. One of the easiest ways to create a more positive experience of access was through giving individuals choices in their care [32]

Remote diagnostics and evaluation

Remote diagnostics and evaluation included assessment of symptoms and physical and mental health conditions of a patient. This allowed to prescribe medication remotely, issue and plan treatment, evaluate environment of a patient

1. Remote diagnostics was particularly useful in functional appointments to renew medication prescriptions or complete quick health check-ups [31]; 2. Remote evaluation of symptoms enabled to recognise signs of acute substance withdrawal, improved evaluation of abuse or neglect and allowed assessment of home environment safety [40]; 3. Having remote assessments, patients experienced a more comfortable environment when staying at home, could express themselves more freely, save transportation time and costs, and/or requested less time off work [42]. 4. Legal hearings on involuntary medication use were held remotely [39]. 5. Patients reported that lack of face-to-face contact made it more challenging for care providers to identify—and help them recognise themselves—signs that their mental health was changing. [55] 6. Care providers argued that remote diagnostics reduced the ability to detect subtle body language, nonverbal cues and physical signs of a disease [42]. The diagnostics included pre-treatment self-assessment and a follow-up by clinicians, standardised measures in assessing treatment effectiveness, symptom evaluation and prescription evaluation. The remote assessment was more effective and robust when performed by video call than by telephone as it allowed inclusion of patients’ appearance, behaviours, movements and affect [40]

Privacy of care providers and patients

Privacy of care providers and patients includes maintaining confidentiality of individuals and sharing information with only those who provide or receive medical care

1. Privacy of patients was difficult to maintain due to other family members at home. Sessions were held with patients in their closets, bathrooms, and cars, while other patients censored themselves due to lack of privacy and the potential of being overheard [35] 2. Treatment units had limited access to visitors which increased patients' privacy and confidentiality [34] 2. Participants' confidentiality was maintained whilst participants were asked to engage in sessions in a quiet, private room. This was not always possible so the privacy of patients was jeopardised [37]; 5. In prison settings correctional officers were positioned outside the closed door of a clinic room to maintain confidentiality [39]

Safety

Safety aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care

1. In prison settings, safety protocols were developed to ensure patients' safety and sessions were held near patients’ housing units to reduce transfers and reduce congregation in waiting areas [39]; 2. In marginalised groups such as homeless people safety standards could not be maintained due to physical restrictions of care providers (such as high presence of drugs) were a source of frustration and led to subsequent care avoidance [32]

Operating hours of service provision

Working hours of face to face or remote service provision have been increased or reduced depending on various factors and conditions

1. Hours of service provision for supporting homeless people in substance use have been significantly reduced to support being available only between 9am to 5 pm. This often led to frustration among participants as they could not access care when they needed it the most and felt that there was a “brick wall” to access support for [32]. 2. Introduced single telephone line working 24/7; new introduced rota for emergency [36] 3. When patients were based in treatment centres (patients in prison) service provision often started from a point of physically escorting a patient to service. With it being remote, service provision reduction was related to decrease of custody care providers’ time to escort patients to treatment units which resulted in a more effective use of care providers’s time [39]