Understanding and accommodating patient and staff choice when implementing video consultations in mental health services.

During the Covid-19 pandemic, some mental healthcare in the United Kingdom has moved online, with more likely to follow. The current evidence-base for video consultations is modest; hence, this study seeks to aid decision-makers by reporting on one large mental health NHS trust's video-consultation pilot project. Patients' choices/preferences were gathered via online forms; staffs' views through a focus group. The typical patient was female, 26yrs, living in a deprived locality. Consultations typically lasted 37 minutes, saving patients 0-30 minutes travel and £0-3.00. Satisfaction was high and the software intuitive. Audio quality varied, but patients felt able to disclose "as if in-person", were willing to use video-consultation again, and found them more preferable than home visits and clinic attendance. Staff could foresee benefits but, were concerned for their therapeutic relationships and avoidant without familiarisation, training, clinical coaching, and managerial reassurances especially regarding high-risk patients/situations. They argued video consultation would not suit all patients and should be employed according to individual need. We found Covid-19 is necessitating staff to adopt video-consultation and that patients are satisfied. However, unless staffs concerns are resolved, enabling them to use their full repertoire of interpersonal skills, therapeutic relationships will trump efficiency and video-consultations may not remain their treatment modality of choice.