Assessing virtual mental healthcare access for refugees during the covid-19 pandemic using the Levesque client-centered framework: what have we learned and how will we plan for the future?
Authours: Michaela Hynie, Annie Jaimes, Anna Oda, Marjolaine Rivest-Beauregard, Laura Perez Gonzalez Nicole Ives, Farah Ahmad, Ben Kuo, Neil Arya, Nimo Bokore, Kwame McKenzie
Location: Alberta, British Columbia, Ontario, and Quebec
Summary
Public health restrictions of the pandemic required mental health services to rapidly transition to virtual care. Virtual mental health services include phone, internet-based voice or video interactions, and text-based applications or messaging.
Although online care can improve access for underserved populations, it may present unique challenges, especially for refugee newcomers. The goal of this research was to document the perceptions of refugee newcomers and key actors involved in the referral and delivery of virtual mental health (VMH) services, to understand how virtual modalities can impact access to mental health services for vulnerable groups.
The study examined the different aspects of access to virtual mental healthcare using Levesque et al.’s Client-Centered Framework for Assessing Access to Health Care. Access is described as a function of the supply and demand sides. The supply side includes: characteristics of the services, service providers, health systems, and organizations. Supply factors are approachability, acceptability, availability and accommodation, affordability, and appropriateness of services. The demand side includes service users and their environments and the factors are: service users' ability to perceive, ability to seek, ability to reach, ability to pay, and ability to engage.
One hundred and eight structured and semi structured interviews were conducted with eight community leaders, 37 newcomer clients, 63 mental health or service providers or managers.
Several overarching themes were identified: challenges with cost; complexity of using technology; comfort for VMH outside clinical settings; sustainability post-COVID-19; and communication and the therapeutic alliance between providers and newcomer service users.
How does this research apply to my work?
Some of the key points providers may find applicable to their work as agencies transition to a hybrid model are:
Virtual care increased the ability to accommodate language needs because it was possible to connect with clinicians or interpreters outside of the immediate community.
Accessing one service increased opportunities for information and awareness of other services, including those related to mental health.
Cultural acceptability played a role in preferences for same-culture therapists and in some cases intersected with delivery modality. Cameras, were described as making some people uncomfortable, such as older adults.
Newcomers reported that feeling welcomed, as opposed to stigmatized, was an important part of accessing and continuing to access services.
The cost of reliable internet or data plans was a pervasive issue for those refugee newcomers who struggled with low income, and it shaped which modalities of care were possible.
Providers raised concerns about the acceptability of virtual modalities for people coping with serious mental illnesses or with clients who were dealing with trauma.
Newcomer clients wanted more flexibility in terms of time of day or days of the week that services were offered but this may conflict with providers' work-life balance.
What should I take away from this research?
The authors explained that the most important and overarching theme was around flexibility, and cited it as a key element favoring access. They noted that providing a choice of different modalities to newcomers (including for in-person services) could improve access in different situations, for different kinds of services, for different mental health concerns, and different individuals. Because of the differences in refugee newcomers’ experiences and needs, offering alternatives, and ensuring clients are supported in making choices, appear to be important factors in reducing each person’s singular set of obstacles to mental health services.
What’s the next step?
The researchers highlighted future studies could examine the perceptions of a wider range of newcomers, including those unable to use virtual modalities, or further inquiry with specific populations: individuals suffering from severe mental health problems, women, seniors, and LGBTQ.
