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Using Digital Mental Health and Measurement-based Care with Youth Experiencing Suicidal Thoughts and Behaviors: A Qualitative Study of Clinician Barriers and Facilitators
ABSTRACT
Background:
Youth suicide is a public health crisis. In addition to suicide mortality, many youth experience and live with suicidal thoughts and behaviors (STBs). STBs have serious consequences for youth mental health – and are associated with suicide. Despite recognition of the incidence and severity of STBs, barriers to accessing support are prevalent. Digital mental health (dMH) and digitally delivered measurement-based care (MBC) may improve youth’s access to treatment and enhance clinical response to suicide risk and crises.
Objective:
The objective of this study was to explore clinician perceptions of the barriers and facilitators to using dMH and MBC with youth experiencing STBs.
Methods:
As part of a larger implementation science project, a dMH and MBC platform was implemented in youth-serving mental health service settings in communities across Alberta, Canada. The platform contains a multidimensional assessment package and embeds an automated suicide escalation protocol that notifies clinicians when youth report STBs. In participating service settings, 32 interviews were conducted with clinicians using dMH and MBC. We utilized the Consolidated Framework for Implementation Research and thematic analysis to identify barriers, facilitators, and relevant themes. Practical implications and recommendations were developed with input from clinicians and researchers.
Results:
Four overarching themes were identified that describe barriers and facilitators to using dMH and MBC with youth experiencing STBs in (1) clinicians’ service settings and practice, and (2) the dMH and MBC platform itself. In clinicians’ service settings and practice, barriers included the incompatibility of crisis notifications with service setting structure, the burden of monitoring the platform, and concerns about clinicians’ capacity to respond to youth experiencing suicidality. The complexity of the platform and continuous crisis notifications for youth with persistent or past STBs were identified as barriers in dMH and MBC. Despite their concerns, clinicians saw that using dMH and MBC collaboratively with youth facilitated the therapeutic relationship and aligned with their service settings’ mission and values. The platform enabled disclosure of STBs and facilitated identification and early intervention by clinicians.
Conclusions:
Given the association between STBs and suicide, attending to STBs is a critical component of suicide prevention. Our findings demonstrate that direct assessment of STBs may address the youth suicide crisis by facilitating disclosure and rapid clinical action. Clinicians delivering dMH and MBC must be supported by applying their recommendations, mitigating barriers, and leveraging facilitators to implementation.
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