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Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review

Appleton, R., Williams, J., Vera San Juan, N. , Needle, J. J. ORCID: 0000-0003-0727-1391, Schlief, M., Jordan, H., Sheridan Rains, L., Goulding, L., Badhan, M., Roxburgh, E., Barnett, P., Spyridonidis, S., Tomaskova, M., Mo, J., Harju-Seppanen, J., Haime, Z., Casetta, C., Papamichail, A., Lloyd-Evans, B., Simpson, A. ORCID: 0000-0003-3286-9846, Sevdalis, N., Gaughran, F. & Johnson, S. (2021). Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review. Journal of Medical Internet Research, 23(12), article number e31746. doi: 10.2196/31746


BACKGROUND: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care.

OBJECTIVE: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation.

METHODS: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis.

RESULTS: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified.

CONCLUSIONS: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these.

TRIAL REGISTRATION: PROSPERO International prospective register of systematic reviews CRD42021211025;

Publication Type: Article
Additional Information: ©Rebecca Appleton, Julie Williams, Norha Vera San Juan, Justin J Needle, Merle Schlief, Harriet Jordan, Luke Sheridan Rains, Lucy Goulding, Monika Badhan, Emily Roxburgh, Phoebe Barnett, Spyros Spyridonidis, Magdalena Tomaskova, Jiping Mo, Jasmine Harju-Seppänen, Zoë Haime, Cecilia Casetta, Alexandra Papamichail, Brynmor Lloyd-Evans, Alan Simpson, Nick Sevdalis, Fiona Gaughran, Sonia Johnson. Originally published in the Journal of Medical Internet Research (, 09.12.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Publisher Keywords: telemental health; COVID-19; remote care; telemedicine; mental health; systematic review, implementation science
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
Q Science > QR Microbiology > QR180 Immunology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
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