7 October 2020

Is it time for Telecounselling to take South Africa’s Mental Healthcare into the future

Insights from a SADAG Survey of patients and mental health professions

The use of technology in the remote diagnosis and treatment of patients defined the ‘telemedicine’ revolution. For the first time, technology was used to connect Doctors and patients, in real time, across vast distances. Telehealth implies an understanding that healing involves many activities including diagnosis, treatment, prevention and health education, and that these can take place using technology, in the form of phones, computers, tablets and the like.

Global and national interest in telehealth was reinvigorated by COVID lockdown and social distancing rules. Numerous studies have documented the immense impact that the virus has had on mental health and well-being across the globe. In South Africa, an online survey conducted by SADAG in April 2020 discovered that depression and anxiety reached record highs during the early days of the lockdown, and with 59% of survey participants previously diagnosed with a mental health condition, the pandemic exacerbated an existing crisis.

Just days after the nationwide lockdown was announced in March 2020, the HPCSA issued new regulations that had special implications for telecounselling. Not only was telecounselling permitted during lockdown, but South African mental health professionals were given permission to consult remotely with new clients. However, this right was not granted to medical doctors, who were only allowed to engage in teleconsultations with their existing patients. In this way, a rather unique telehealth-telecounselling opportunity was created for mental health practitioners by the HPCSA. While telehealth is not a new development in South Africa, the events of 2020 created a set of circumstances that could possibly lead to a telecounselling revolution for the future.

Understanding telehealth for mental health in South Africa, especially during lockdown, where people couldn’t see their healthcare professionals face to face, the rise of telehealth provided a possible solution to ensure that people with mental health issues still got support, counselling and treatment. SADAG conducted an online survey of 200 patients/clients and 109 mental health professionals to explore their lived experiences, challenges and insights from using online, virtual and remote telehealth sessions during COVID.

While the survey sample sizes are in no way numerically or proportionally representative of the South African population, the lived experiences of both groups add much value to gathering important insights into telehealth during COVID and beyond. Most reported mental health issues from both patients and mental health professionals was Depression, Generalised Anxiety Disorder, Panic Attacks, Suicide Ideation and Trauma.

While patients and mental health professionals used a combination of Zoom, Whatsapp, Skype and MS Teams for online telehealth consultations – Zoom was the most used platform for online telehealth sessions with 58% of patients and 81% of mental health professionals using Zoom.

Some advantages of telehealth were that 77% of mental health professionals stated that they could reach new clients during lockdown, while a further 65% of mental health professionals stated that telecounselling allowed them to reach clients in outlying and rural areas during lockdown.

Over half of clients (52%) who had engaged in some form telecounselling would like to continue with remote mental health support practices post-lockdown, while the remaining 48% of patients would prefer not to and would like to do face-to-face session. 87% of mental health professionals preferred to continue remote counselling going forward, with one practitioner hopeful that ‘Telehealth is here to stay’.

Perhaps the revolution has begun out of necessity, but it might soon become a stronger movement towards remote mental health care out of preference, if accompanied by the necessary structural changes.

For the full SADAG Online Survey Findings, infographic and article, please visit www.sadag.org .

Telecounselling from a client’ perspective

• 27% of clients had experienced some form of remote counselling before lockdown
• 64% did so during the lockdown
• There was a 47% increase in the number of telecounselling clients due to the lockdown
• 25% of clients believe that trust could be forged between therapist and client during remote consultations.
• Pro-telecounselling clients felt the telecounsellors had understood their problems; assisted in problem-solving; helped clients to feel better during remote consultations that lasted a sufficient amount of time
• Clients found it to be cheaper and easier to access remote mental health support; whilst offering greater privacy
• 58% of all clients sampled felt that despite a preference for face-to-face counselling, they would support telecounselling as remote mental health care was defined as better than no support
• 41% expressed a preference for face-to-face counselling but were more willing to embrace remote counselling under emergency conditions

Telecounselling from the professionals’ perspective

• The greatest challenge is the inability to maintain adequate work/life
• The absence of non-verbal cues negatively impacted assessments carried out by over half of the practitioners surveyed
• 58% complained of the hampering effects of poor internet connectivity
• 41% maintained that they could reach more clients than before
• The professionals surveyed reported that approximately 9 in 10 clients were successfully treated via teleconsultations
• Formal consent processes were handled smoothly via remote means across 90% of the sample, with Zoom and WhatsApp proving the most utilised platforms
• Only 69% of telecounsellors were paid in full by client medical aids
• 87% of professionals who offered pro bono remote mental health care consultations