Moving to tele-mental health in humanitarian and crisis settings: an evaluation of the experience of Médecins Sans Frontières during the COVID-19 pandemic – World
Khasan Ibragimov, Miguel Palma, Gregory Keane, Janet Ousley, Madeleine Crowe, Cristina Carreño, German Casas, Clair Mills, Augusto Llosa & MSF Mental Health Task Force
“Tele-mental health (MH) services” are an increasingly important means of extending care to underserved groups in low-resource settings. In order to continue to provide psychiatric, psychotherapeutic and counseling care during the movement restrictions related to COVID-19, Médecins Sans Frontières (MSF), a humanitarian medical organization, has abruptly transferred part of its SM activities to humanitarian contexts and limited resources to a remote format.
From June to July 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff’s perceptions of tele-SM services. The preliminary quantitative results influenced the design of the qualitative question guide. Eighty-one quantitative online questionnaires were collected and a subset of 13 in-depth qualitative follow-up interviews took place.
Respondents from 44 countries (6 geographic regions), mainly from sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions relied on audio-only platforms (80%). 30% of respondents said that more than half of their patients were unreachable using these interventions, usually due to poor network coverage (73.8%), lack of communication devices (72.1%) or a lack of private space at home (67.2%). %). Almost half (47.5%) of respondents felt that their staff had a reduced ability to deliver comprehensive mental health care using telecommunications platforms. Most respondents thought DM staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-SM services had some degree of usefulness, including better access to care (37.7%) and time efficiency (32.8%). ). The qualitative findings highlighted a myriad of challenges, including in establishing therapeutic alliances, caring for vulnerable populations, and those inherent in communication infrastructure.
Tele-MH services were seen as a feasible alternative to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the settings studied, particularly survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MS disorders. Audio-only technologies that lacked non-verbal cues were particularly difficult and made risk assessment and emergency care more difficult. Before considering tele-MH services, the communication infrastructure must be assessed and comprehensive, context-specific protocols must be developed.