Table 2.

Groups identified as particularly at risk of disadvantage from remote care

Groups at risk of disadvantage from remote care	Example quotations
Individuals with sensory (eg, hearing) difficulties and communication impairments.	We work with over 65s, so we know that a lot of those are people who have hearing difficulties and it can be incredibly difficult for them to get the same out of the telephone session as they do in person. (Senior clinical psychologist) I was working with a family that the [family member] had a stroke and can only write, and the family do a lot of her communicating in the family sessions. And they said there’s just no way we can do that online, it’s going to all… it’s just going to stress her out completely. So people who have got additional needs that don't get met by the online platform. (Family therapist)
Individuals for whom interacting through a screen or via telephone may be particularly challenging.	I felt really not looked after in the community, the way they were proposing to help us was just calling, which is not very adequate for me because I have Asperger’s and I really need something physical. (Service user) I assessed a person with autism, and it was challenging. 'Cause I think if you struggle with human interaction in person, you probably struggle even more online. (Trainee psychiatrist)
People who may be unfamiliar with, or unwilling to use, technology (‘digital exclusion’), including older adults and individuals experiencing phobias or delusions regarding IT.	Ours is an older population generally speaking, and not to stereotype, but a lot of the older population are not technology savvy, a lot don’t have smart phones, a lot don’t have iPads or computers. So, we haven't video called most of them, or a lot of them. It tends to be that we're just making lots and lots of telephone calls. (Care coordinator) [Family member] won’t Zoom. Part of his schizophrenia is he can’t look at live television so, Zoom, he couldn’t do. This is him personally I’m talking about rather than in general. But (…) I get to know about a lot of other cases… and we are unanimous(it’s)not just schizophrenia (…)… Face to face is invaluable. (Carer) There’s one person who I’m still in contact with over the phone but she’s phobic about technology, partly due to a previous trauma issues. (Clinical Psychologist)
People who may not have access to technology or telephone/ internet contracts (including those without a secure accommodation)	I have people who don’t have internet access, don’t have mobile phones, so if I don’t go to their house, I’m not going to engage with them. (Care coordinator) Well, I guess people in social economic kind of situations where they don't allow them to have the devices, so families that don't have devices or Wi-Fi, that might be more difficult. (Family therapist)
Non-native English speakers (and those needing a language interpreter) for whom relaying only on verbal communication may constitute an obstacle to mutual understanding.	But [remote access] is limited, it relies on people having good English, whereas we have quite a high Turkish population here. (Trainee psychiatrist) A lot of our patients, because of the demographic, English may not be their first language or they may have an accent if they’ve grown up abroad, which can add to the difficulties in understanding people on the phone. (Trainee psychiatrist)