1 - (SYM 29) Using a Mixed-methods Approach to Understanding Provider Perspectives of Treatment Waiting Lists and Use of Low-intensity Treatments (LITs)

Introduction: Waiting lists are a considerable barrier to mental health treatment for common mental disorders like depression and anxiety. Waiting time is associated with worsening symptoms and a poorer experience with treatment when it is accessed. Low-intensity treatments (LITs), like bibliotherapy or internet-based treatment, may be possible resources to assist individuals waiting for treatment, though it is not well understood how providers perceive the possibility of using LITs for patients on their waiting lists.

Methods: We surveyed 141 practicing mental health providers (e.g., therapists and psychologists) on their waitlist practices and attitudes towards LITs. Sixty-five responders also completed an open text box to report additional considerations. Responses were qualitatively coded into themes to understand barriers and facilitators to recommending LITs.

Results: Most participants reported keeping a waiting list, and few reported recommending LITs, though most were willing to use one for patients on their waiting list. Attitudes toward LITs were generally neutral to positive. Guided LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Qualitative outcomes yielded 11 themes in the open response data: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress.

Discussion: Providers currently do not suggest LITs, or many other resources, for patients on treatment waiting lists, but may be willing to do so. Provider concerns highlighted in qualitative data included the potential for suggesting a LIT that would ultimately be inappropriate for their patient due to a lack of assessment of the patient's needs ahead of time. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient, suggesting that it may feel safer for a provider to do nothing rather than provide a potentially unsuitable LIT. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care, and more work is needed to determine who is appropriate for LIT use.