Our rapid review found that articles describing mental health-based virtual services and standards offered a wide range of recommendations for practitioners, standards were also generated after focus group and interview sessions with participants.
Standards were generated that will help patients, healthcare providers, and policymakers to ensure that mental health issues are appropriately supported in primary care settings
Here are the list of the proposed standards:
- All patients should have a standardized assessment of symptoms and severity completed prior to or during every mental health-related appointment, if presenting with symptoms/conditions (such as anxiety or depression) for which standardized assessments exist.
- All staff interacting with patients (including primary care providers, clerical staff, nurses, etc.) should receive specific training about how to conduct virtual care appointments for mental health issues, including: technical aspects of care, appropriateness, guidelines and ethics.
- All patients should receive a list of local crisis resources either during or after an appointment for mental health concerns.
- Anticipated response time (how long patients can expect to wait between communicating with their provider and receiving a response) should be agreed on between providers and patients and documented in the medical record.
- An emergency contact should be documented in the medical record of anyone accessing virtual mental health care, to be used in case the patient abruptly disconnects or discloses information that results in concern about imminent harm.
- Providers should ask patients during virtual mental health appointments whether they are in a setting that is sufficiently private for them to be comfortable continuing with the appointment.
- Patient screening for virtual mental health care should include asking patients about their preference for modality (in-person, phone, video).
- All patients should be informed of safety protocols – for example, what will happen if they hang up in the middle of an appointment – in place prior to commencing virtual mental health care.
- Primary care providers and patients should discuss whether patients intend to record virtual mental health appointments, and the outcome of this conversation should be documented in the medical record.
- If disclosure by a patient of substantially traumatic events is anticipated, an in-person appointment should be recommended in the first instance instead of a virtual modality.
- Patients and providers should discuss whether limited visibility of body language (either through telephone or video calls) could impact the quality of assessment that can be provided, and should collaboratively establish a plan for future care if this is anticipated to be a substantial barrier.
- Patients without access to longitudinal primary care should still be able to access virtual mental health care and services through episodic care options such as ‘virtual walk-in clinics’.
- Peer support opportunities should be offered to older patients who disclose during a virtual mental health consultation that they are experiencing psychological distress.
- American Sign Language – trained providers should be available for Deaf patients accessing virtual mental health care.
- Patients from equity-seeking groups should have opportunities for prioritized access to virtual mental health care services.
- Virtual mental health care services provided to patients with mental health concerns should be appropriate and cognizant of the needs and preferences of both patients and providers.
- Patients with mental health concerns should have access to clear, unambiguous information about what virtual mental health services are available and covered by medicare in their province/territory.
- Patients should be provided with resources to support safe and effective use of technology for virtual mental health care, such as guidance for what is an appropriate setting for an appointment.
Canadian Standards for Virtual Delivery of Mental Health Services in Primary Care 