key: cord-304219-tmlatghe authors: Ojha, Rashi; Syed, Saba title: Challenges faced by mental health providers and patients during the coronavirus 2019 pandemic due to technological barriers date: 2020-06-03 journal: Internet Interv DOI: 10.1016/j.invent.2020.100330 sha: doc_id: 304219 cord_uid: tmlatghe BACKGROUND: The novel coronavirus, SARS-CoV-2, has been responsible for the devastation of hundreds of thousands of lives directly and has caused disruptions globally. Vulnerable populations, specifically those suffering from serious mental illness and homelessness, are at higher risk of contracting COVID-19 infection resulting in medical complications and psychiatric destabilization. In addition, mental health has become increasingly relevant throughout the country given the psychological distress people have been facing due to the spread of COVID-19 and the toll of a more restricted way of living. Although the healthcare industry has quickly integrated novel ways of treating patients with mental illness with technological advances, these technologies are not applicable to different populations equally. There is a clear disparity that is represented within the public county health systems, which leads to a widening gap between those who receive adequate treatment for mental illness and those who do not. AIMS: The aims of this paper were to provide a commentary on the benefits of technology-based psychiatric and psychological interventions based off experience in a public health system and based off a relevant, thorough literature review. In addition, we aim to highlight the importance of accessibility of these interventions for vulnerable populations and provide recommendations for integrating these services expeditiously. METHODS: Literature review was conducted using MEDLINE, PubMed and Google Scholar. CONCLUSIONS: Based off data collected from experience in a public health system and literature review, we conclude that although the COVID-19 pandemic has initiated significant innovation to integrate technology for psychiatric care, this innovation is not equally accessible for vulnerable populations suffering from mental health disorders. Within a public county health system, there are barriers with providing mental healthcare to vulnerable populations. These barriers, which are applicable throughout the United States, serve as a rationale for the need of innovative solutions for the integration of these services in not only emergency situations such as the COVID-19 pandemic, but also in daily non-emergent operations to sufficiently address the needs for those needing mental healthcare. J o u r n a l P r e -p r o o f 3 Based off data collected from experience in a public health system and literature review, we conclude that although the COVID-19 pandemic has initiated significant innovation to integrate technology for psychiatric care, this innovation is not equally accessible for vulnerable populations suffering from mental health disorders. Within a public county health system, there are barriers with providing mental healthcare to vulnerable populations. These barriers, which are applicable throughout the United States, serve as a rationale for the need of innovative solutions for the integration of these services in not only emergency situations such as the COVID-19 pandemic, but also in daily non-emergent operations to sufficiently address the needs for those needing mental healthcare. The unprecedented outbreak of the COVID-19 pandemic has been a catalyst for an overnight transition to telehealth services across heath care systems. While people across demographics have needed increased health services, most health systems, particularly those dealing with underserved populations, are technologically ill-equipped. Patients with severe mental illness die earlier, have more medical illnesses, and receive worse medical care than those in the general population (1). This healthcare disparity is accentuated in the area of mental health services, where the clinical systems lack technological sophistication to meet the challenges of the pandemic. Social isolation and psychological stress related to the pandemic can lead to anxiety, fear and depression. In addition, mentally ill patients, particularly the homeless, socially disadvantaged, drug addicted or Communication-based technologies, which includes telephone communication, interactive audio and video interfaces, text messages and remote monitoring of patient data comprise of the wide range of telemedicine or telehealth (2) . Telepsychiatry, or telemedicine interventions for psychiatry, can include psychiatric evaluations, therapy, patient education and medication management. Telepsychiatry is highly efficient and clinically acceptable, with 80% of clinically stable patients, particularly with a known psychiatric disorder, able to be managed with teleconsultation alone (3) . Some of these interventions can include direct, real-time interaction between a psychiatrist and patient (eg. videoconferencing). Other types of digital or tele-based mental health interventions, which can complement telepsychiatry, include online mental health surveys, telephonebased hotlines, online mental health educational materials and psychological counseling services (4). These complementary interventions, particularly those involving smartphone applications, have shown to have a moderate positive effect on some mental health disorders, such as depression. (5) In the United States, the repertoire of tools used within telemedicine were primarily reserved for physician-patient interactions where distance was the major barrier. While these tools have been used for decades, there are multiple legal and policy-related reasons why they have not been integrated widely (2) . Telehealth has been implemented in a J o u r n a l P r e -p r o o f 5 painstaking fashion, and though substantial effort has gone into scaling telehealth services, less than 1% of individuals living in rural areas (where telehealth services are primarily catered towards) have experienced such services (6) . The COVID-19 pandemic has increased the expeditious adoption of telemedicine, telepsychiatry and digital health interventions, but there are existing barriers to continue the utilization of these services. Telepsychiatry can be implemented in a cost-effective way but increasing awareness and creating "how-to" guides catered towards different populations is essential. For example, in the Los Angeles county, 47.5% of the population is Hispanic and/or Latino and 13.8% is Asian, and creating "how-to" guides in English, Spanish and different Asian languages would be helpful in ensuring each of these populations were able to understand how to access online mental health services. incomes below $30,000 do not own a smartphone, 44% don't have home broadband services and 46% do not own a computer. Comparing these results to households with an annual income of $100,000 or more, these technologies, including tablets, are nearly ubiquitous. (19) This disparity is particularly relevant to the LAC health system, as a significant portion of the population includes those from a low socioeconomic status, including minority populations and the homeless. Temporary funding sources may be adequate to address emergencies such as this pandemic. (6) This would provide funding for specific services or target vulnerable patient populations to mitigate high-risk, high-demand situations. (6) The incorporation of telehealth services in a sustainable fashion requires a multi-level, interdisciplinary strategy. In order for telehealth services to be embedded in daily operations for healthcare In conclusion, the COVID-19 pandemic has been challenging globally and has forced many to consider different ways to approach their jobs. This is extremely relevant to healthcare professionals, many of whom are on the frontlines and selflessly treating patients. Mental health has risen to the forefront of many people's lives, and they are forced to confront the ephemeral predictions of shelter-in-place predictions and change their routines. Unfortunately, despite the increased awareness mental health has received, many patients with severe mental illness have fallen through the cracks. In order to best serve our patients today and prevent these problems from happening to future patients, those who desperately require appropriate treatment and planning and those who often lack sufficient support systems, we utilize the Los Angeles County Health System as a model to be a stimulus for enduring, positive change. J o u r n a l P r e -p r o o f The impact of serious mental illness on health and healthcare COVID-19 is catalyzing the adoption of teleneurology Response to: Rethinking online mental health services in China during the COVID-19 epidemic Online mental health services in China during the COVID-19 outbreak The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19) Medicare Telemedicine Health Care Provider Fact Sheet The outbreak of COVID-19 coronavirus and its impact on global mental health 2019-nCoV epidemic: address mental health care to empower society Inevitable isolation and the change of stress markers The psychological effect of severe acute respiratory syndrome on emergency department staff Rethinking online mental health services in China during the COVID-19 epidemic Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health care setting Patients with mental health disorders in the COVID-19 epidemic Older adults perceptions of technology and barriers to interacting with tablet computers: a focus group study Digital Divide Persists Even as Lower-Income Americans Make Gains in Tech Adoption 70% Of Seniors Are Now Online and Using Technology CMS Expands COVID-19 Telehealth Reimbursement to Therapists Technology Use and Attitudes among Mid-Life and Older Americans Progression of mental health services during the COVID-19 outbreak in China Mental health problems of prison and jail inmates Notification of Enforcement Discretion for Telehealth