Table 4.

Themes and subthemes of the qualitative analysis

Theme	Subtheme
Changes on a structural level	Digitalisation and telemental health
	Discontinuation of MHS vs. open and functioning services
	Worsening of access
	Increase in administration efforts and lack of financial support
	Impairment of professional training
Changes on the users’ level	Negative impacts on well-being
	COVID-19-pandemic as a new topic in therapy
Changes on the staff level	Changes in team climate and teamwork dynamics
	Changes in work procedures and administration
	Decrease of employees’ well-being
Network of MHS	Importance of having a network
	Obstacles to a functioning network
Problematic issues and criticism	Equivocality of Covid-19 regulations
	Defective flow of information
	Lack of attention for MHS
	Deficiencies in digital infrastructure
	Intensification of existing problems
Positive aspects of the pandemic	Increasing awareness for uncontrollable life events
	Flexibility and capacity to adapt
	Learning effects
	Users’ capacity to deal with crisis situations
Wishes for future emergency situations	Overview of available MHS
	Consideration of users’ and relatives’ perspectives
	Specific measures for vulnerable group
	Consistent and clear communication
	Mental health as part of policies
	Financial support of MHS
	Low-threshold access to MHS
	Reflection on how to keep services in emergency situations running
	Outpatient care as the way forward
Four different phases of change	1st lockdown: uncertainty
	Summer 2020: “Normality”
	2nd lockdown: “COVID-19 Fatigue”
	Begin of vaccinations

MHS mental health services