Facilitating Mental Health Treatment Engagement in Integrated Primary Care: Examining Canadian Perspectives on the Utility of Virtual Warm Handoffs Amidst COVID-19 and Beyond

Abstract

Introduction: In light of the pervasive detrimental impacts of the pandemic on mental health¹, integrated primary care (IPC) has been increasingly considered to meet the rising demands for accessible, regulated mental health care in Canada. Within IPC settings, the use of a “warm handoff” has previously been found to promote treatment engagement yet currently, no literature exists regarding the potential impact of the virtual context on the effectiveness of warm handoffs.² Thus, the current study compared the impact of various types and contexts of virtual mental health referrals on the likelihood of referral acceptance and continued treatment engagement. Methods: Undergraduate participants (N = 560; MAge = 20.6 ± 3.9)—who reported moderate symptoms of both depression (MPHQ = 10.1 ± 6.6) and anxiety (MGAD = 9.4 ± 5.6) on average—were randomized into one of three video vignette conditions: 1) warm handoff in IPC, 2) referral as usual in IPC, or 3) referral as usual in standard primary care. Participants were asked to imagine that they were attending virtual appointment with their family physician, during which they received a corresponding referral for their mental health concerns. Next, they indicated their likelihood of accepting the referral and continuing to engage with treatment.Results: After controlling for mental and physical health status, significant associations were found between the referral type and the likelihood of referral acceptance (χ2 = 23.32; p < .05) and continued engagement (χ2 = 46.37; p < .001). Specifically, those who received a warm handoff (b = 0.36; p < .01; OR = 1.43) were significantly more likely to accept the referral compared to those who received a referral as usual in standard primary care. Relatedly, those who received either a warm handoff (b = 0.65; p < .001; OR = 1.92) or a referral as usual in IPC (b = 0.30; p < .01; OR = 1.35) were both more likely to engage in continued treatment compared to a referral as usual in standard primary care. Furthermore, nearly 80% of participants indicated a willingness to access IPC psychological services if they were available through their physician.Conclusion: Altogether, these results indicate that virtual integrated primary care services—and moreover, the use of virtual warm handoffs—foster significantly greater likelihood to accept and continue to engage with mental health services compared to the community services many individuals are referred to through the current fragmented primary care system. Implications: Given these results, we offer the recommendation to implement virtual warm handoffs as a routine component of virtual integrated primary care practice. Future research should focus on optimizing this process by examining patient and provider perspectives on the advantages of and operational barriers to using a virtual warm handoff.