The Road to Digitally-Driven Mental Health Services: Remote Psychological Interventions

Introduction

Living with a mental illness continues to pose countless personal, family, and societal challenges. Although most mental illnesses have recognized effective interventions, these treatments are not yet available to all. In recent years, this reality has also been negatively impacted by new phenomena, such as mass displacement of populations, psychosocial risks associated with work, with particular emphasis on emerging risks, and the COVID-19 pandemic that at the end of 2019 ravaged the world, affecting the way of living.

After the appearance of the first case of COVID-19 at the end of 2019, and the declaration of a global pandemic by the WHO on March of 2020 (WHO, 2021a), healthcare systems all over the world had to rapidly adapt to the new contingencies (Bilder et al., 2020). At the time of the writing of this chapter, 177,106,695 cases of the disease were confirmed all over the world, with 3,840,223 deaths being the direct result of it (WHO, 2021). Considering COVID-19’s rapid spread, restraining measures hae been constantly applied all over the world until the current time. For example, in Portugal, similar to other countries, measures like national lockdowns (in 2020 and 2021), restriction of movements, physical distancing, prophylactic isolation, and quarantines were applied not only to mitigate the spread of the virus but also, and importantly, to reduce the pressure imposed to the national health system due to COVID-19 (Direção Geral de Saúde (DGS), 2021).

Reports from the Eurofound (2020, 2021) shed light on the fact that over one fifth of European citizens that answered the survey have missed at least one health-related examination or appointment during COVID-19. The reasons pointed by the participants of the survey were, among others, the lack of availability of health services due to the pandemic, long waiting lists, fear of contracting the virus, and lack of money to attend the appointments or to do the examinations. In the European Union, Hungary, Portugal, and Latvia were the countries where the reported values of unmet need for healthcare were higher (Eurofound, 2020, 2021). Similarly, a study about the impact of the COVID-19 pandemic on healthcare services in Portugal (Ordem dos Médicos et al., 2021) found that 57% of the Portuguese people considered that COVID-19 made the access to healthcare services more difficult; the most affected segments of the population seem to have been the elderly (69%) and people with chronic diseases (70%). The same study also found that three in every ten people that felt sick during the pandemic did not use healthcare services and that the main reason for not seeking or not attending healthcare services during the pandemic was the fear of being infected with SARS-CoV-2. These results are in line with a study from Nielsen & Leckovich (2020) that reported that the feelings of fear and numerous concerns about the potential exposure to the virus led to self-isolation and avoidance of in-person health care services, which meant thatproper care for some diseases might not have been provided.

In response to COVID-19, however, a rapid and widespread use of telemedicine was prompted all over the world (Madigan et al., 2021). For example, in Portugal, a growing of 101% was registered from 2019 to 2020 in remote medical consultations of primary care, accompanied by a decrease of the appointments in the clinical context (-38%) and at home (-37%) (Ordem dos Médicos et al., 2021). The total number of consultations in the primary care context (considering remote, clinical context and at-home consultations) actually grew; the same did not happen in the hospital context with a decrease of 11% compared to the same period of the previous year was registered in 2020.