To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients' experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient's experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint.

BackgroundDepression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone.ObjectiveThis analysis assesses patient’s acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking.MethodsThe Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study is a randomized controlled trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for the treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion.ResultsDuring the consent process, 17.1% (114/667) patients referred to the study declined to participate and 57.0% of them (65/114) attributed their refusal to research-related factors (ie, randomization and time commitment); a further 16.7% (19/114) declined owing to the telephone delivery of the intervention. Among the 377 participants who were randomized to the 1-year intervention, the overall retention rate was 82.8% (312/377). Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97% (38/39) of comments related to the telephone components were positive with key reported positive attributes being accessibility, convenience, and privacy.ConclusionsOur results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy.Trial RegistrationClinicalTrials.gov NCT02345122; https://clinicaltrials.gov/ct2/show/NCT02345122 (Archived by WebCite at http://www.webcitation.org/73R9Q2cle)

C ollaborative mental health care involves primary care providers and mental health specialists working together in structured ways to improve access to care, quality of care and outcomes. 1,2 It is one of the most empirically supported approaches to achieving good outcomes in primary mental health care 2-7 and is integral to mental health and primary care strategies in Canada. 8-12 However, well-studied effective models of collaborative care have not been implemented in Canada. 13,14 The Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs) (Clinicaltrials. gov, no. NCT02345122) was designed to address geographic and human resource barriers that impede the implementation of collaborative care. It was a pragmatic randomized controlled trial assessing the implementation and effectiveness of a collaborative care model delivered by telephone versus enhanced usual care for people experiencing depression, anxiety or at-risk drinking, including mild to moderate alcohol use disorders. 15 The study intervention included telephone-based symptom monitoring and self-management support provided by a care manager, and recommendations from a psychiatrist to guide pharmacotherapy provided by primary care providers. The study outcomes were reduction in symptom severity and improved quality of life, measured 4, 8 and 12 months after baseline. The study had lower than expected referral rates. 16 We conducted a qualitative study with the aim of exploring primary care providers' experiences of PARTNERs, understanding barriers to and facilitators of collaborative care interventions and research, and informing the design of future studies.