Choosing Virtual Versus In-Person Mental Health Crisis Care: A Theoretical Framework for the Decision-Making Process From the Patient's Perspective.
Angela Buchel, Jocelyne Lemoine, Danielle Carignan Svenne and 2 others
PMID 42046276WHAT IT FOUND
Patients described virtual crisis care as a first step or compromise when they feared forced inpatient admission.
Most in-person survey respondents still preferred facility-based care, and many had not known virtual was an option.
Key findings
01Most in-person crisis unit survey respondents said they would use in-person services in a future crisis, only 2.6% would use virtual services, and 28.9% had previously known the virtual unit existed.
02Interviewed patients reported different referral pathways: 3 said the clinician suggested virtual care, 4 said in-person care, 8 said they were given both options and chose, and 6 said it was unclear.
03The framework grouped decision influences into clinical or safety risk, environment, technology, systems, and expectations for care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The survey was voluntary and web-based, and no hard-copy responses were submitted, so people without an email address may be missing. The analysed sample was small: 76 in-person survey respondents, 28 virtual survey respondents, and 21 interview participants. Many in-person respondents were unfamiliar with the virtual unit, and the study did not specifically include people who were offered virtual care and declined. Clinician perspectives on the decision were not explicitly collected, although clinicians made the recommendations. The crisis units were subacute services for people who did not require inpatient psychiatric admission, so the framework may not apply to higher-risk crises. The virtual unit operated within a Canadian service structure with existing virtual care infrastructure, so transfer to other settings may be limited. The study developed a qualitative decision framework; it did not test whether virtual crisis care improves symptoms, safety, or access compared with in-person care.
Declared interests
Funded by the Canadian Mental Health Association Joule and Manitoba Medical Services Foundation. Drs Hensel and Bolton reported consulting fees from the Health Sciences Centre Foundation for advising on virtual care planning.
The easy way to misread this
Do not conclude that virtual crisis care is clinically safer or preferred by most patients. It is a qualitative framework from patients already using subacute crisis units, and 76.3% of in-person survey respondents said they would still choose in-person care in a future crisis.