LAUSR

BACKGROUND Tele-mental health care has been rapidly adopted to maintain services during the COVID-19 pandemic, and there is now substantial interest in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw not only on COVID-19 experiences, but also on the substantial research evidence accumulated prior to this. OBJECTIVE To conduct an umbrella review of systematic reviews of research literature and evidence-based guidance on tele-mental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting pre-defined criteria. Reviews retrieved were independently screened and those meeting inclusion criteria were synthesised and assessed for risk of bias. Narrative synthesis was used to report findings. RESULTS Nineteen systematic reviews met the inclusion criteria. Fifteen examined clinical effectiveness, eight reported on aspects of tele-mental health implementation, ten reported on acceptability to service users and clinicians, two on cost-effectiveness and one on guidance. Most reviews were assessed as low quality. Findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short-term. Evidence was lacking on the extent of digital exclusion and how it can be overcome, and on some significant contexts such as children and young people's services and inpatient settings. CONCLUSIONS This umbrella review suggests that tele-mental health has potential to be an effective and acceptable form of service delivery. However, we found limited evidence on impacts of large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for future tele-mental health implementation. CLINICALTRIAL