The VHB is a demonstrably useful accessory to treatment-an easily accessible tool that can increase stress coping skills. Because the app is easily disseminated across a large population, it is likely to have broad, positive utility in behavioral health care.

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Objective This study explored patient perspectives of how online access to Veterans Affairs (VA) clinical notes (OpenNotes) may affect relationships with their mental health clinicians. Methods Semi-structured qualitative interviews were conducted with 28 patients receiving VA mental health care who had used OpenNotes. Transcripts were coded and analyzed using a constant comparative approach. Results Respondents consistently reported that clinician-patient relationships—feelings of trust in particular—are critical to the therapeutic process, and that reading clinical notes strengthens or strains trust in mental health clinicians. Perceptions of transparency and respect as conveyed in notes were central to maintaining trust. Conclusions Findings suggest that ensuring consistency between what occurs during appointments and what appears in clinical notes, as well as highlighting patient individuality and strengths in notes, may help engender patient trust and avoid negative consequences of OpenNotes in mental health care.