LEVEL SOURCE/ENTRY INITIATOR GOALS/AIMS QUESTIONS AND PERSPECTIVES LIABILITIES OTHER COMMENTS 1 Website information and support/chat groups Health information: gain perspective, obtain standard and updated info Answers, tips and perspective How should I approach the problem? What should I do or what are others doing? Quality of information and lack of regulation Better if referred by clinician who has evaluated the materials 2 Formal educational materials Person/patient: education Caregiver: education, supports, and advice Clinician: continuing medical education An effort to improve or to show effort (if referred by other)? Using evidence-based or “sound” info Documenting progress Less interaction with instructors or clinicians May present a learning style mismatch Better if referred by clinician who has evaluated the materials 3 Self-directed assessment and care Person/patient: good habits, reflection tips Caregiver: reflection tips, tools to assess loved ones Clinician: tips on clinical care, options to refer patients If it is my preference/style (or I have limited resources), what can I accomplish? Is this problem serious? Can my patients do some of this outside the office? Not all problems can be self-assessed Some illnesses affect our insight Is it “really good,” though? Better if referred by clinician who has evaluated the materials 4 Assisted self-care assessment, traditional evaluation and decision-making, and automated support systems Person/patient/caregiver: empowering Clinician: skepticism unless the resource is of known quality and reputation Empowering and increased self-efficacy/confidence in next step? Could this address MH provider shortage and costs? Risk of oversimplification and misdiagnosis in receiving an opinion without them knowing you Alternative might be members of an interdisciplinary team or lower-cost providers 5 Asynchronous, between-session clinician contact Person/patient/caregiver: contact, advice Clinician: don’t make quick decisions, not that simple, and preference to schedule/bill Builds relationship and clinician is “available” Patient-clinician may have different styles; things taken out of context; and miscommunication Needs new models of clinical support Will most likely increase over time 6 Synchronous, traditional or e-MH care Person/patient: gold standard of care with more research Clinician: if patients like it, it is a good option There is no shortcut to synchronous decision-making (patient-clinician; primary care-psychiatry) It always has to be scheduled (and paid for) A great option; not always needed due to lesser, easier options

Table 1: The Continuum of Internet-Based Options For Informal Mental Health (MH) Education, Self-Directed Care and Traditional Care.