Choosing Virtual Versus In-Person Mental Health Crisis Care: A Theoretical Framework for the Decision-Making Process...

Area of Science:

• Mental Health Services Research
• Health Informatics
• Clinical Decision Support

Background:

• Hospital-level care decisions are complex, with virtual options adding further considerations.
• Patient reluctance towards in-person crisis stabilization is a significant challenge in mental healthcare delivery.

Purpose of the Study:

• To develop a theoretical framework guiding decision-making for in-person versus virtual crisis stabilization support.
• To understand patient and clinician factors influencing the choice between virtual and in-person mental health services.

Main Methods:

• A constructivist grounded theory approach was employed, analyzing interviews with virtual Crisis Stabilisation Unit (CSU) users (N=21) and survey data from in-person CSU users (N=76).
• Web-based surveys and semi-structured interviews were conducted between March 2022 and May 2023.
• Purposive sampling ensured representation of virtual service users for in-depth analysis.

Main Results:

• A decision-making framework was developed, integrating clinical/safety risks, technology, environment, and system factors.
• Patient desires and clinical recommendations led to agreement or compromise through negotiation.
• Virtual services were often perceived as a beneficial first step, though some patients retained fears of involuntary confinement.

Conclusions:

• Virtual crisis stabilization presents a viable and acceptable alternative for patients hesitant about in-person care.
• Clinical recommendations must holistically consider patient-specific, environmental, and technological elements.
• Clinicians should embrace virtual care as a patient-centered option when appropriate.