Guidance for virtual mental health services: a rapid review of guidelines and recommendations from high income countries

Context: The COVID-19 pandemic has resulted in widespread adoption of virtual modalities – phone and video - to provide outpatient healthcare. Concurrently, there has been a substantial increase in the incidence of mental health concerns, such that the use of virtual modalities for mental health concerns has now become a common aspect of outpatient care practice in general, and primary care in particular. Despite this, there is limited guidance available for effective use of virtual care for mental health concerns in primary care.

Objective: To identify existing recommendations and guidelines for virtual delivery of outpatient mental health services, and the strengths and gaps therein.

Study Analysis and Design: Systematic literature review using ‘rapid review’ methodology, with qualitative content analysis of included resources focused on themes related to the Quadruple Aim, which is an established framework for optimizing health system performance through the achievement of: improved patient and provider experiences, reduced costs, and improved population health.

Setting or Dataset: References in peer-reviewed databases published from January 1, 2010 to July 1, 2022; focus on ‘high-income’ countries as defined by the World Bank.

Population Studied: We focused on resources related to adults accessing outpatient mental health care through general practice, family medicine, psychology or psychiatry settings.

Intervention/Instrument: ‘Virtual care’ broadly defined including phone and video consultations.

Outcome Measures: Description of themes.

Results: From 2769 reviewed articles, we identified 38 related to recommendations for virtual mental health services. We identified the following themes: Screening patients for appropriate/optimal use of virtual care; Emergency contacts; Transparent provider-patient communication; Accessibility; Supporting equity-seeking populations; Cost effectiveness of virtual care; Virtual care coverage; Increasing provider training for virtual care; Setting professional boundaries.

Conclusions: Existing literature on virtual delivery of mental health services includes recommendations for how to support patient experience, but there is limited guidance around improving provider experience, or how virtual services could improve population health. More specific guidance is needed to support equitable, effective virtual mental health care delivery.