Table 5.

Levels of adoption and coverage of telemental health during the COVID-19 pandemic.

Author	Type of service	Service location	Adoption/coverage data
Anton et al [44]	General hospital/physical health service	United States	77% (n=20) of those approached via telephone enrolled in the program, higher than the observed in-person rates of 61%. 80% of patients who were contacted by phone in the hospital agreed to be enrolled, lower than the 98% success rate when staff approaches patients in person at the bedside. 100% of patients who received in person care and 100% on the waitlist (n=5) transitioned to telepsychotherapy.
Barney et al [45]	CMHTa and outpatient services	United States	The percentage of provider telemedicine visits increased from 0% to 97%. The number of overall clinic visits did not decline when compared with that a year before (337 visits in March 2019 vs. 332 visits in March 2020), No-show rates were comparable between remote and face-to-face care.
Békés et al [47]	CMHT and outpatient services; psychology/psychotherapy/counseling service; private hospital/clinic	Canada, United States, Europe (countries not stated)	Before COVID-19 an average of 23 sessions (SD 10.58) per week were conducted in person, 3 sessions (SD 2.28) by phone, and 1 session (SD 2.84) online via videoconferencing. During COVID-19 an average of 7 (SD 7.91) of the in-person sessions changed to sessions by phone, and 15 (SD 10.33) to online sessions.
Benaque et al [48]	Voluntary sector/nonprofit organization	Spain	Initially, average weekly visits dropped from 657 to 254 in the first week after the state of alarm was declared. This drop was of 44% for follow-up visits and 40% for on-demand consultations. By week 16 the total number of visits (n=514; 78%) was almost up to prepandemic levels.
Boldrini et al [52]	CMHT and outpatient services; psychology/psychotherapy/counseling service; private hospital/clinic	Italy	42.1% (SD 28.9) of their psychotherapy treatments were interrupted during the lockdown. The remainder of their treatments was primarily delivered via online video (63.7% [SD 38.3]) or telephone (29.1% [SD 25.3]). 7.2% (SD 15.1) of their treatments were delivered face-to-face.
Carpiniello et al [54]	CMHT and outpatient services; inpatient mental health service	Italy	75% of appointments were switched to remote. Telehealth modalities used were mainly phone calls (100% of the Italian Departments of Mental Health), videocalls (67%), or emails (19%), with 41% of units adopting all these means of contact.
Chen et al [56]	General hospital/physical health service	United States	The outpatient psychiatry division switched from under 5% virtual visits in March 2019 to over 97% in March 2020. Productivity was maintained at about 95% of previous levels, with 9206 virtual visits in March 2020. Between March 30 and April 24, 2020, 30% of the virtual visits were conducted via phone.
Childs et al [57]	CMHT and outpatient services	United States	Before COVID-19, 100% of care was delivered in person. In the first week after shutdown, telehealth comprised 65.45% of visits (100% over the telephone). In the second week, 91.6% of visits were conducted using telehealth (83.49% over the telephone and 15.6% video). By the third week 99% of appointments used telehealth (30% using video). The percentage of appointments using video increased weekly, peaking at 69.9%
Colle et al [58]	CMHT and outpatient services	France	After 2 weeks of teleconsultations, 376 (91.0%) out of the 413 previously planned appointments were performed.
Connolly et al [29]	CMHT and outpatient services; Veterans Affairs service	United States	Daily TMH-Vb encounters rose from 1739 on March 11 to 11,406 on April 22 (556% growth, 222,349 total encounters). Between March 11 and April 22, 114,714 patients were seen via TMH-V. A total of 88,908 (77.5%) were first-time TMH-V users. A total of 12,342 mental health providers completed a TMH-V appointment between March 11 and April 22; 4281 (34.7%) were first-time TMH-V users. Daily telephone encounters rose from 6348 on March 11 to 34,396 on April 22 (442% growth). Daily in-person encounters fell from 57,296 on March 11 to 10,931 on April 22 (81% decrease).
Dores et al [60]	Psychology/psychotherapy/counseling service	Portugal	During the lockdown period, 17 (15.7%) of the 108 psychologists discontinued therapy and counseling; 53 (58.2%) continued to provide services to most or all of their clients; 23 psychologists (25.3%) decreased the number of clients they saw to a range of between 0% and 25%, and for another 15 psychologists (16.5%) that number diminished to a range of between 26% and 50%.
Erekson et al [61]	Psychology/psychotherapy/counseling service	United States	Attendance rates for individual therapy temporarily dropped by about 35% but climbed to previous levels within 2 weeks. Group therapy attendance dropped by about 30% but did not fully recover, remaining about 15% lower after 2 weeks. The number of clients receiving individual therapy in 2020 dropped by 43%. Between March 22 and April 4, 2020, the service had fewer than half the intakes of any other recent year.
Gaddy et al [65]	Music therapy service	United States	Of the 869 respondents indicating current contact hours, 70.54% reported that they were providing alternative services, including telehealth services (54.81%), virtual music lessons (17.01%), prerecorded songs/playlists (16.98%), and prerecorded video sessions (16.00%). Individual services increased (mean 61.58% [SD 41.26], whereas group services decreased (mean 24.97% [SD 37.56]).
Gomet et al [67]	General hospital: addiction service	France	100% of service users took part in remote care
Graell et al [68]	CMHT and outpatient services; inpatient mental health service	Spain	During the study period, a total of 1818 outpatient consultations were carried out: 1329 (73.10%) by telephone or videoconferencing and 489 (26.9%) face-to-face.
Grover et al [69]	CMHT and outpatient services	India	The majority of the patients reported that they were in touch with their treating doctor (81.5%), with contact initiated by the treating team in 79% of patients.
Grover et al [70]	CMHT and outpatient services; inpatient mental health service; private hospital/clinic	India	Use of teleservices almost doubled during the lockdown period: 206 (52%) participants provided telecommunication services during the lockdown period, 186 (47%) provided free tele-consultation to the general public, and 269 (67.9%) provided free tele-consultation to their patients; 132 (33.3%) were using both voice and video calls (combination of free and paid services), 31 (7.8%) were using only voice calls (combination of free and paid services), and 31 (7.8%) were using only voice calls (combination of free and paid services).
Grover et al [71]	Medical colleges, government-funded institutes mental hospital setting, general hospital psychiatry units	India	Around 25% of institutes began offering telemental health services; 45.9% of institutes reported that telecommunication services continued during lockdown. Mental health services were being provided to people in quarantine (66.1%) and those with COVID-19 infection (59.6%), family members of patients with COVID-19, and those in quarantine (40.4%).
Humer et al [75]	Psychology/psychotherapy/counseling service	Czech Republic, Germany, Slovakia	Among all countries, the combined (personal contact + telephone + internet) number of patients treated on average per week during COVID-19 (mean 18.32 [SD 12.86]) did not differ from the combined (personal contact + telephone + internet) number of patients treated on average per week in the months before the COVID-19 situation (mean 19.35 [SD 13.73]), t337=−1.506; P=.133.
Humer et al [75]	Psychology/psychotherapy/counseling service	Austria	During the COVID-19 pandemic, face-to-face psychotherapy remained the most abundant treatment modality.
Khanna et al [79]	CMHT and outpatient services	Australia	There was a 3% increase in appointment bookings compared with the same period in 2019. Cancellation/nonattendance rate dropped from an average of 19% last year to 12% for 2020
Kopec et al [80]	CMHT and outpatient services	United States	Prior to COVID-19, Network180 served an average of 2390 patients/month, which decreased to an average of 1921 patients/month during the pandemic. This decrease was noted most significantly in crisis services (averaging 822 patients/month before COVID-19 and 640 patients/month during COVID-19). Telehealth increased from 5% of all services prior to COVID-19 to 84% of all services during COVID-19. The majority of services provided via telehealth were audio only (versus audiovisual), with a ratio of 1.9:1 for crisis services and 4:1 for noncrisis services.
Looi et al [84]	Psychiatrist telehealth service	Australia	Percentage of consultations conducted using telemental health—ACT: 62% (April), 58% (May); NT: 53% (April), 51% (May); SA: 69% (April), 58% (May); Tasmania: 38% (April), 40% (May)
Looi et al [85]	Psychiatrist telehealth service	Australia	The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Percentage of consultations conducted using telemental health—NSW: 56% (April), 52% (May); QLD: 63% (April), 53% (May); VIC: 61% (April), 59% (May); WA: 51% (April), 36% (May)
Lynch et al [86]	CMHT and outpatient services	United States	The service continued providing all services except community-based coaching via telehealth. 90% of patients with complex psychosis accepted telehealth sessions and maintained their specific treatment plans. 2 opted out of telemental health. Mean comparisons between session attendance and cancellations/no-shows during the 6-week period before and after telehealth conversion showed no significant differences in service utilization.
Medalia et al [88]	CMHT and outpatient services	United States	Tracking the number of RS enrollees with active participation indicated that in the week before telehealth conversion, when shelter-in-place recommendations commenced, participation dropped from 94% to 52%; after telehealth conversion, participation rose from 67% in the first 4 days to 79% after 1 week and to 84% after 2 weeks.
Miu et al [89]	CMHT and outpatient services	United States	A total of 816 participants comprised the analytic sample. A total of 400 converted to telehealth and of those 64 were SMIc. The conversion rates from in-person psychotherapy to teletherapy were similar for SMI (n=64, 51.6%) and non-SMI (n=334, 48.3%) groups. The rate at which the SMI group converted from in-person therapy to teletherapy (52%) was not statistically different from that of the non-SMI group (48%) during COVID-19.
Patel et al [91]	All National Health Service Trust services	United Kingdom	From March 2020, in‐person contacts reduced substantially from around 9000 per week to 3000 per week in early April 2020. Over the same period there was an increase in remote contacts from around 2500 per week in early March 2020 to around 8000 per week by the end of April 2020. Total clinical contacts per week dropped from around 12,500 in mid‐March to around 10,000 in mid‐April 2020. The number of unattended appointments was temporarily reduced in April, May, June, and September 2020.
Pierce et al [93]	Variety of MH service settings	United States	Psychologists estimated that telepsychology comprised 85.53% of their clinical work during the pandemic, compared with the prepandemic context when only 7.07% of their clinical work was conducted remotely.
Probst et al [94]	Psychology/psychotherapy/counseling service	Austria	Face-to-face psychotherapies in personal contact were reduced and remote psychotherapies (via telephone or internet) were increased in the early weeks of the COVID-19 lockdown as compared with the months before. Although average increases in psychotherapies via telephone (979%) or via internet (1561%) were dramatic, there was an undersupply of psychotherapy in Austria in the early weeks of the COVID-19 lockdown as the total number of patients treated on average per week was lower in COVID-19 lockdown than in the months before.
Reilly et al [95]	Various service types	United States	There was uptake of telemental health by approximately 80% of respondents by late March or early April 2020. All but 2.11% (19/903) of providers in this study made practice adjustments (transition to telemental health).
Rosen et al [98]	VHAd mental health services	United States	VHA provided nearly 1.2 million telephone and video encounters to veterans in April 2020 and reduced in-person visits by approximately 80% when compared with the October 2019 to February 2020 period before the pandemic. By June 2020, VHA had an 11-fold increase in encounters using direct-to-home video and a fivefold increase in telephone contacts relative to before the pandemic. VHA reduced in-person visits by approximately 80% when compared with the October 2019 to February 2020 period before the pandemic.
Scharff et al [100]	Community-based training clinic providing therapy	United States	The Psychological Services Centre saw an initial retention rate of 82% in the first week of teletherapy, with more clients resuming services in the weeks that followed.
Schlegl et al [101]	Inpatient mental health service	Germany	More than 80% of patients with bulimia nervosa received face-to-face therapy before the COVID-19 pandemic (81.8%) compared with 36.4% during the pandemic (ie, a decrease by 55.5%). Use of videoconference-based therapy increased from 3.6% to 21.8% and use of telephone contacts from 18.2% to 38.2%, whereas the use of additional online interventions decreased from 3.6% to 0%. Face-to-face psychotherapy decreased by 56% but videoconferencing therapy was only used by 22% of patients.
Sciarrino et al [102]	Veterans Healthcare Administration	United States	Approximately 76% of veterans engaged in posttraumatic stress disorder treatment chose to continue despite the COVID-19 pandemic via telehealth.
Sequeira et al [103]	Residential services	United States	After transition to teletherapy, the average daily virtual program census from March 19, 2020, to April 18, 2020, was 3.3 intensive outpatient program patients and 22.4 outpatients. These numbers indicate a slight decrease in intensive outpatient program patients (−0.3/per day) and an increase in outpatients seen per day (+2.7/per day). There was an increase in the outpatient sessions retained and a decrease in the appointments cancelled.
Severe et al [104]	CMHT and outpatient services	United States	Take up for remote care was over 95%; 82.8% (n=202) initially chose to receive psychiatric care through video visits, whereas 13.5% (n=33) chose telephone visits; 1.2% (n=3) decided to postpone care until in-person visit availability.
Sharma et al [28]	General hospital/physical health service	United States	By March 20, 2020, 67% of all outpatient appointments were conducted at home. Most of these appointments were conducted by phone with some TMH sessions. By March 27, 2020, 90% of all outpatient appointments were done at home, predominantly by phone (59%) but increasingly by HB-TMHe (31%). One week later (April 3, 2020), these rates were 48% versus 45%, respectively. By March 31, 2020, 98% of faculty completed expedited training and obtained departmental approval for HB-TMH services during the COVID-19 crisis. By April 10, 2020, HB-TMH was offered to all established outpatients for individual visits. Only the crisis clinic continued a regular in-clinic presence.
Sheehan et al [105]	CMHT and outpatient services	United Kingdom	64% were spending at least some time working from their workplace (either solely or in combination with home working); 33.9% were working from home only. Just over a third were at the workplace (n=178, 35.1%) and the remainder (n=147, 28.9%) worked from both home and at the workplace.
Termorshuizen et al [107]	CMHT and outpatient services	The Netherlands and United States	Most transitioned to telehealth care (United States 45%; Netherlands 42%), with fewer still receiving face‐to‐face care (United States 3%; Netherlands 6%), or not having been able to engage with their provider at all (United States 6%; Netherlands 5%).
Uscher-Pines et al [108]	CMHT and outpatient services and private hospital/clinic	United States	Most of the psychiatrists had transitioned to fully virtual practices. Only a quarter of the participants were seeing any patients in person.
Uscher-Pines et al [109]	CMHT and outpatient services; private hospital/clinic; general hospital/physical health service	United States	Telemedicine use: None (in-person only), 1 (5.6%); phone only, 2 (16.7%); video only, 0 (0.0%); combination of video and phone, 15 (83.3%).
van Dijk et al [110]	CMHT and outpatient services; psychology/psychotherapy/counseling service	The Netherlands	Treatment adherence was 100%.
Yellowlees et al [115]	General hospital/physical health service	United States	By the second day after shutdown, only 8% (n=52) of our appointments were in-person clinic visits, compared with our baseline average of 98%. By the third business day, 100% (n=73) of appointments were conducted virtually, with 92% (n=67) via videoconference and 8% (n=6) by phone.
Zulfic et al [116]	CMHT and outpatient services	Australia	Some patients still required regular face-to-face reviews, including the 91 patients (29%) who are treated with depot medications and 71 (23%) taking clozapine.

^aCMHT: community mental health team.

^bTMH-V: telemental health: video.

^cSMI: serious mental illness.

^dVHA: Veterans Health Administration.

^eHB-TMH: home-based telemental health.