JMIR Publications

ABSTRACT

Background:

Suicide is one of the most pressing public health issues in the United States, inflicting a devasting toll on families, communities, and society. Individuals with suicide risk often visit emergency departments (EDs) but the setting has chronic shortages in psychiatric care staffing, which results in gaps in best practices, prolonged length of stay for patients and unnecessary inpatient admissions. To improve behavioral health care and suicide prevention practices, we implemented telehealth-based mental health evaluations with enhanced suicide care at two EDs in Massachusetts. Little is known about patient experiences and perceptions towards appropriateness of telehealth for emergency mental health evaluations in the context of suicide prevention. The goal of our qualitative study was to understand patient and provider experiences with this program, and to gain insight on aspects of the implementation process.

Objective:

The goal of the current qualitative study was to ascertain patient and provider perceptions of a telehealth program to improve suicide prevention in EDs and its implementation process. We sought to understand current gaps in knowledge related to patient and provider experiences with emergency telemental health evaluations while also informing recommendations for implementation that may improve suicide prevention efforts in EDs across the nation.

Methods:

We conducted 25 semi-structured qualitative interviews with patients who received a telemental health evaluation and clinicians, including behavioral health and ED providers, whose clinical workflows included the new telehealth implementation. We used a rapid approach to qualitative analysis and were guided by key implementation a priori domains outlined in the PRISM framework.

Results:

Patient and providers reported their perceptions of the patient care experiences and recommendations related to implementation. Patients’ perspectives were highly varied, with several factors and priorities contributing to their views on telemental health in this setting. Overall, patients valued transparency and informed decision-making, which extended to having the option to choose between an in person or telehealth evaluation. Providers generally felt that in person evaluations were preferable, but that given long wait times and staffing concerns, telehealth evaluations offered a strong alternative. Both patients and providers reported several recommendations for future implementation efforts, including increased support and information, communication throughout the process, and improving overall psychiatric care in the ED.

Conclusions:

Given current shortages in behavioral health care, emergency telemental health evaluations could provide an opportunity to reduce wait times and support the delivery of best practice, suicide-related care. However, their implementation has the potential to exacerbate existing issues related to patient autonomy, therapeutic alliance, and care transitions. Our study contributes to a gap in knowledge related to patient and provider experiences of this telehealth service and describes factors that impact implementation, which may inform future care advances by clinicians and administrators.