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

introductionDecisions around receiving hospital-level care are complex; the addition of a virtual option introduces additional considerations.

aimTo develop a theoretical framework for the decision-making process regarding in-person or virtual-based crisis stabilisation support.

methodWeb-based surveys emailed to all individuals admitted to in-person and virtual Crisis Stabilisation Units between March 2022 and May 2023. Purposive sampling identified interview candidates based on use of the virtual service. A constructivist grounded theory approach started with analysis of the interviews and triangulated with survey data from in-person service users.

resultsSurveys (N = 76 in-person users) and interviews (N = 21 virtual users) were analysed. The decision-making framework highlighted clinical and safety risk, technological, environmental and systems factors within the clinical recommendation. The recommendation was either congruent or incongruent with the patient's desires leading to agreement or compromise through negotiation. Many patients viewed the virtual service as a good first step in care, while some continued to fear forced confinement. DISCUSSION: Many patients are reluctant to accept in-person crisis stabilisation, and the virtual option provides an acceptable alternative. Clinical recommendations should consider patient, environmental, and technological factors. IMPLICATIONS FOR PRACTICE: Clinicians must be willing to consider when virtual care may be an acceptable patient-centred option.