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

1. Introduction

1.1. Background

In 2020, the Scottish Government commissioned Dr Nadine Cossette to examine the mental health needs of people hospitalised due to COVID-19. Dr Cossette’s report, Meeting the Mental Health Needs of Patients Hospitalised Due to COVID-19, highlighted that the effects of severe COVID-19 often continued after a patient left hospital, with approximately one-third of COVID-19 patients admitted to hospital developing serious mental health consequences, including depression, anxiety, PTSD, and cognitive problems. The Cossette report identified that mental health services in Scotland are not currently configured to meet these needs, nor do they have the capacity.

Dr Cossette’s 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. 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.

1.2. The Mental Health After Covid Hospitalisation (MACH) service

At the time of this research, thirteen health boards in Scotland are currently providing a MACH service. A range of different professions are involved in delivering the service in each board, including psychology, psychiatry, mental health nursing, and occupational therapy.

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 using a questionnaire pack designed to identify common psychological problems (for example, mood changes, fatigue or cognitive problems). Patients 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. Support for MACH is provided by a National Specialist Advisory Group (NSAG), which offers multidisciplinary clinical expertise.

1.3. Research aims and objectives

This research explores the MACH service from the perspective of practitioners and National Specialist Advisors from the NSAG 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.

1.4. Research methods

Fourteen participants, consisting of clinicians delivering local MACH services (11) and members of the NSAG (three), were recruited on a voluntary basis. A qualitative approach was taken involving individual interviews with the three NSAG members and one clinician (four in total), and one focus group with ten NHS clinicians. All interviews were conducted virtually, audio recorded and transcribed.

The interviews were semi-structured, giving participants and the interviewer latitude to explore emergent topics. To capture learnings from different stages of the service development, the interview questions were structured around the set up of MACH, delivering the service, and looking to the future. Anonymised quotes from select interviewees are included in this report.