Mental Health after Covid Hospitalisation (MACH) service: exploratory qualitative study

Executive summary

In 2020, the Scottish Government commissioned Dr Nadine Cossette to examine the mental health needs of people hospitalised due to COVID-19, leading to the publication of Meeting the Mental Health Needs of Patients Hospitalised Due to COVID-19 report. The report made six recommendations, one of which included establishing a network of mental health clinicians across Scotland to screen and treat those who had been hospitalised due to COVID-19. 5.6. The Scottish Government have made £4.5 million available over three years (this is the final year) to facilitate development of the network, known as the Mental health After Covid Hospitalisation (MACH) service.

MACH is based on a ‘screen and treat’ model of service delivery. All patients who have been hospitalised due to COVID-19 are proactively contacted by their local MACH service. Patients are then screened and those who screen positive are then invited for an assessment with a senior mental health clinician. Following this initial assessment, patients may be given self-management information, referred to third sector or other NHS services, and/or be offered further treatment by the MACH service.

This qualitative research explores the MACH service from the perspective of practitioners and advisors involved in the set up and delivery of MACH with a view to understanding how the service has been implemented and developed since it was launched. It provides insight about the learning emerging from the development and delivery of MACH as well as potential areas for improvement.

The research explores four elements of the MACH service:

• enabling factors which facilitated the set up and delivery of the MACH service
• barriers and areas of difficulty which were experienced in the set up and delivery of the MACH service
• areas identified for improving the delivery of MACH or a similar service
• key overarching learning which could be valuable legacies of the MACH service

Facilitators to MACH included:

• The practical approach taken by the Scottish Government to setting up the service, which included engaging with clinicians to identify patient needs and how a service could meet these needs. Health boards were given the latitude to implement their own MACH service to suit local circumstances.
• The professional networks and peer support structures put in place to support MACH, which provided both clinical and operational advice, and allowed for learning to be shared nationally.
• Positive team dynamics across MACH services and within the professional support structures previously noted, which helped to forge and sustain connections between different services.
• Taking a digital approach to connecting MACH services, which was valued, as this enabled networking opportunities and helped connect services from more rural parts of Scotland.
• The outreach approach to delivering MACH, where the service contacts potential patients.

Several barriers to setting up and delivering MACH were identified. These included:

• The limited resources, including both staffing and space limitations.
• The high administrative workload, due to factors such as the burden of screening patients and the lack of administrative resources, which meant some clinicians had to priorities administrative work over clinical time.
• An emergent mismatch between MACH staffing and patient needs, with some elements of MACH services being underutilised and aspects of patient needs not being met.
• Challenges in the onward referral of MACH patients to other services.

Based on the views of the participants, this research identified several areas in which MACH could be improved. These included:

• Implementing service guidelines to support service implementation and delivery.
• Adopting a wider, multidisciplinary approach to delivering MACH, as this might help better meet some of the wider needs of MACH patients that were being identified (e.g. poor physical health).
• Engaging with a wider range of patients, beyond solely those hospitalised with COVID, to possibly include those with COVID who received treatment in the community or people suffering from long COVID.
• Improving patient signposting, to improve linkages with other services and possibly improve referral outcomes.

Key learning elements from the MACH service, which could be used to inform further service provision included:

• The success of the proactive approach to reaching out and contacting patients. Strengths of this included that it may have exerted a preventative effect by bringing people into contact with a service before their symptoms worsened or their needs became more complex.
• The screening of patients ahead of them potentially receiving treatment, which meant that patients could potentially receive the right kind of support sooner.
• The interlinking of MACH services, which helped facilitate cooperation at a national level and the sharing of skills and knowledge.

While this research has provided some important early learning about the facilitators, barriers and key learnings from the implementation of MACH in Scotland it has several limitations. These relate to a lack of direct patient voice, with this research solely based on views of healthcare professionals, a lack of comparisons between MACH services across Scotland, and the use of focus groups to conduct this research rather than individual interviews, which may have influenced the data collected.