Table 5 Lived experience commentary by Beverly Chipp & Karen Machin, members of the NIHR Mental Health Policy Unit's Lived Experience Working Group

This systematic review reveals the lack of knowledge on how best to implement telemental health (TMH). The included studies refer to a range of settings, dates, TMH applications and patient groups making it difficult to draw a single conclusion which might work across them. Participants’ age likely affects affinity for technology (not recorded in 8 studies), and other demographic and cultural factors may impact on access. Implementation strategies might vary across healthcare systems internationally, and the pandemic impacted on available resources and funding streams which may have influenced procurement choices

The underlying assumption is that TMH is beneficial. New technology is generally viewed as progress, but in health and social care the most important consideration should be human relationships, both with patients and between staff. Technologies may disturb these relationships and the full implications upon both workforce and healthcare are yet to be considered. For example, service users emphasise that choices are essential, including the option of whether to use TMH or not. However, anecdotal evidence suggests that some clinicians view choosing TMH over face-to-face appointments as a reluctance to fully engage

The conclusions of this study seem rather obvious for any new development: that offering training and ongoing support would help. Training needs will differ significantly from familiar SMS messages to bespoke software, but in any case this assumes the intervention is known to be comparatively effective and desirable for all parties

Future studies should pay specific attention to what is useful for which groups of people, including adaptations to context, before progressing to investigate implementation. Inevitably, any singular approach will leave some communities excluded

Fundamentally, we would argue that consumers provide the ultimate litmus test of acceptability and effectiveness for any TMH modality. Co-production, from design stage to evaluation, is surely key to the success of any implementation