key: cord-0735750-9ku9dlsp
authors: Yu, G.; Craig, D.; Fu, Y.
title: The impact of changes in mental health services in response to COVID-19 on people with mental health conditions: protocol for a rapid review
date: 2022-02-15
journal: nan
DOI: 10.1101/2022.02.15.22270931
sha: 06d9e902e4e3e34c614961739a13914222d44f86
doc_id: 735750
cord_uid: 9ku9dlsp

Introduction The COVID-19 pandemic has caused disruptions to mental health services, forcing the rapid implementation of alternative ways of delivering services alongside a greater immediate, and continuously growing, demand across those services. The care and level of mental health service provided are felt to be inadequate to respond to the increasing demand for mental health conditions in the time of the pandemic, leading to an urgent need to learn from service change and consequences to inform solutions and plans to support the NHS post-pandemic plan in the UK. This rapid review aims to understand the changes in mental health services during the pandemic and summarise the impact of these changes on the health outcomes of people with mental health conditions. Methods and analysis Cochrane CENTRAL, MEDLINE, EMBASE, and PsycInfowill be searched for eligible studies with key terms indicating mental health AND COVID-19 AND health services. Studies will be included if objective and subjective effects of changes to mental health services in response to COVID-19 are reported on adults with mental health conditions, peer-reviewed and published in the English language. Study selection and data extraction will be undertaken dependently by two reviewers. Evidence will be summarised narratively and in a logic model. Ethics and dissemination Ethics approval is not required for this review. A list of interventions/services/models of care delivered to people with mental health conditions will be grouped as "Do", "Don't" and "Don't know" based on the evidence on effectiveness and acceptability. The results will be written for publication in an open-access peer-reviewed journal and disseminated to the public and patients, clinicians, commissioners, funders, and academic conferences. PROSPERO registration number CRD42022306923

The COVID-19 pandemic has caused disruptions to mental health services, forcing the rapid 3 implementation of alternative ways of delivering services alongside a greater immediate, 4 and continuously growing, demand across those services. The care and level of mental 5 health service provided are felt to be inadequate to respond to the increasing demand for 6 mental health conditions in the time of the pandemic, leading to an urgent need to learn 7 from service change and consequences to inform solutions and plans to support the NHS 8 post-pandemic plan in the UK. This rapid review aims to understand the changes in mental 9 health services during the pandemic and summarise the impact of these changes on the 10 health outcomes of people with mental health conditions. 11 Methods and analysis 12 Cochrane CENTRAL, MEDLINE, EMBASE, and PsycInfowill be searched for eligible studies 13 with key terms indicating mental health AND COVID-19 AND health services. Studies will be 14 included if objective and subjective effects of changes to mental health services in response 15 to COVID-19 are reported on adults with mental health conditions, peer-reviewed and 16 published in the English language. Study selection and data extraction will be undertaken 17 dependently by two reviewers. Evidence will be summarised narratively and in a logic 18 model. 19 Ethics and dissemination 20 Ethics approval is not required for this review. A list of interventions/services/models of 21 care delivered to people with mental health conditions will be grouped as "Do", "Don't" and perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in 1 • This is a rapid review with a systematic search of literature 2 • Evidence on changes to mental health services and associated health outcomes will be 3 examined to make practice recommendations 4 • This review will provide the evidence base to inform solutions and plans to support the 5 mental health service provision for the post-pandemic period 6 • Some limitations to the study design include limited to OECD studies, exclusion of non-7 English studies, publication bias, quality of data, selection bias, and no quality 8 assessment in the rapid evidence review. 9 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The NHS has set up a long term plan to improve mental healthcare services that are widely 24 regarded as being under-resourced. 8 However, for people with mental health conditions, 25 there is an incomplete picture of the impact of the pandemic on the pattern of mental 26 health services. Despite bringing current service inadequacies to the forefront, the 27 pandemic could provide an opportunity to rethink conventional approaches to mental 28 health services planning to meet patients' needs. For example, remote community 29 treatment and support has long been suggested but has not previously been implemented 30 widely because of barriers and challenges from both healthcare staff and service users. 31 Since the onset of the pandemic, the situation has changed. 9 Similarly, the threshold for 32 hospital admission for mental illness varies between individuals and requires continuous 33 adaptation over time. Therefore, learning from health service changes throughout the 34 pandemic, and their consequences for people's physical and mental health is vital to inform 35 practical policy solutions for integrated service recovery and effectively plan services that 36 reach those with the greatest need. 37 The WHO recommends rapid review methods as an efficient approach to provide rapid but perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in 1 A rapid review will be undertaken to provide an evidence base supporting the 2 recommendation of mental health services and identify areas where the evidence base is 3 lacking, and future research is required. The review will be guided by the Cochrane guidance 4 for rapid reviews 18 . Preferred Reporting Items for Systematic reviews and Meta-Analyses 5 extension for Rapid Reviews guidance 19 will be followed for reporting. 6 This protocol has been developed in advance of the review to improve the transparency and 7 quality of the methods to help reduce bias and enhance the reproducibility of the results. 8 This has been registered with the PROSPECT CRD42022306923. Studies identified from databases will be exported to EndNote X9 22 for deduplication. Study 38 titles of abstracts will be screened independently according to the selection criteria. Any 39 results that are inconclusive at the initial screen will be included and considered at full-text 40 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted February 15, 2022. ; https://doi.org/10.1101/2022.02.15.22270931 doi: medRxiv preprint screening. All full-text papers will be screened independently by two researchers (GY and 1 YF). Any discrepancies will be resolved by discussion and consensus. Where there is a 2 disagreement between two reviewers, a third researcher (DC) will be consulted to reach a 3 consensus. 4 Data extraction 5 A data extraction sheet will be designed to capture information including author's first 6 name, publication date, setting, study design, sample size, mental health conditions, 7 characteristics of participants, service components, service provider, method of delivery, 8 resources required, outcome measures and main study results. GY will extract all the data. 9 YF will check for accuracy and completeness through random double-extraction of 10% of 10 included studies. Where a study appears to have multiple citations, original authors will be 11 contacted for clarification. All information from multiple citations will be used if no replies 12 are received.

Quality assessment and quality control 14 This is a rapid review, so no quality assessment will be conducted. This can be done 15 retrospectively if time and resources allow. 16 The following steps will be taken to ensure quality control for the searching, screening, data 17 extraction, and coding process. GY will conduct screening and data extraction following pre-18 determined inclusion criteria and data extraction framework. For articles that are retrieved 19 and full text saved, YF will check 10% of the coding to ensure they meet the screening 20 criteria. Where there is a disagreement between two reviewers, a third researcher (DC) will 21 be consulted to reach a consensus. Synthesis of each outcome will be conducted by GY and 22 independently revised by YF.

A tabulated and narrative synthesis of the results will be undertaken following current best 25 practice 23-25 to conduct synthesis systematically and transparently. It will focus on the 26 mental health services, mechanisms and their impact on health outcomes. A logic model will 27 be produced to present context, service provision and outcomes. Possible unintended 28 adverse outcomes will also be reported. Also, a list of interventions/services/models of care 29 delivered to people with mental health conditions will be grouped as "Do", "Don't" and 30 "Don't know" based on the strength of the evidence on effectiveness and acceptability.

If data is available, outcomes of studies will be synthesised according to characteristics of 32 study participants, for example, deprived communities, ethnic minorities, to produce 33 evidence on health inequalities that is likely to have been exacerbated during the pandemic. 35 This study has been designed and developed in consultation with two public members (one 36 with lived experience), to ensure their input on the study design. They both read and 37 commented on the review summary, search strategies, eligibility and plans to synthesise 38 data and dissemination strategies. They valued the potential impact of this review on NHS 39 plans for mental health post-pandemic. It has been agreed that the process of this rapid 40 review will be presented to both members for their further comments. 41 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted February 15, 2022. ; https://doi.org/10.1101/2022.02.15.22270931 doi: medRxiv preprint ETHICS AND DISSEMINATION 1 As this rapid review will only consider published literature, no ethics approval is needed. 2 Dissemination will be led by the research team and supported by the public member and 3 the wider project advisory group. Results of this review will contribute to reports which will 4 be produced and shared with the National Institute for Health Research (NIHR)Three 5 Research Schools and NIHR Applied Research Collaboration (ARC) North East and North 6 Cumbria (NENC). The findings will be published in peer-reviewed journals and a plain study 7 summary will be disseminated to people receiving mental health care, groups and forum 8 that the project public members are connected, practitioners and commissioners. An 9 abstract will be prepared for academic conferences such as the Society for Academic 10 Primary Care Annual Conference. Accepting the potentially increased risk of biases introduced by rapid review methods is a 24 compromise for many rapid review protocols. 26 The decision to restrict the evidence review 25 to OECD studies, research published in English and a limited number of databases, and not 26 to undertake a formal quality appraisal exercise will increase the risk of bias and the 27 likelihood that relevant research may be missed or excluded. To help mitigate the 28 limitations of the proposed study design, strategies such as regular team meetings 29 throughout and publishing the protocol in advance of conducting the review have been 30 employed. Furthermore, a quality appraisal may be undertaken retrospectively at a later 31 date for a more comprehensive assessment of the evidence. 32 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The authors declare that they have no competing interests. 12 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted February 15, 2022. ; https://doi.org/10.1101/2022.02.15.22270931 doi: medRxiv preprint

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Rapid reviews to strengthen health policy and systems: a 23 practical guide: World Health Organization

The healthcare improvement Scotland evidence 25 note rapid review process: providing timely, reliable evidence to inform imperative decisions 26 on healthcare

A scoping review of rapid review methods

Rapid review programs to support health care and policy 30 decision making: a descriptive analysis of processes and methods

Advancing knowledge of rapid reviews: an analysis 33 of results, conclusions and recommendations from published review articles examining rapid 34 reviews

A typology of reviews: an analysis of 14 review types and associated 36 methodologies

COVID-19 disrupting mental health services in most countries, WHO 38 survey

Impact of the COVID-19 pandemic-a mental health service 40 perspective

Updating guidance for reporting systematic reviews: 44 development of the PRISMA 2020 statement

Worlds of Healthcare: A Healthcare System Typology of OECD 47 Countries

EndNote X9 version

Improving Conduct and Reporting of Narrative 2 Synthesis of Quantitative Data (ICONS-Quant): protocol for a mixed methods study to 3 develop a reporting guideline

Guidance on the conduct of narrative synthesis in systematic 5 reviews. A product from the ESRC methods programme Version

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Expediting systematic reviews: methods and implications of rapid 9 reviews