Implementation Strategies to Improve Outpatient Mental Health Treatment Initiation for Primary Care Patients With Suicidal Thoughts and Behaviours: A Scoping Review.

backgroundPrimary care is a common healthcare contact before suicide. When suicide risk is identified in primary care, patients are often referred to specialty outpatient mental health care. However, many do not initiate care. Strategies to improve the initiation of specialty outpatient mental health care among adults in primary care settings with suicidal thoughts and/or behaviours remain unclear.

methodsThis scoping review operationalized implementation strategies used in primary care to facilitate the initiation of specialty mental health care. We used established methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, CINAHL, Embase, PsycInfo, and Google Scholar were searched for peer-reviewed articles in English that contained implementation strategies to improve the initiation of specialty outpatient mental health care among adults in primary care settings with suicidal thoughts and/or behaviours. We excluded abstracts, editorials, grey literature, and studies focused on intensive outpatient or partial hospitalisation programmes. At least two independent reviewers screened, completed a full-text review, and extracted study data. Implementation strategies were labelled and defined using the Expert Recommendations for Implementing Change (ERIC) strategies and operationalized using recommended reporting guidelines.

resultsOf the 606 citations screened, five studies were retained. An average of 8.6 unique strategies per study were identified. No study used an established taxonomy of strategies to label and define strategies nor stated all recommended reporting details. Common strategies aligned with ERIC strategies to 'promote adaptability', 'develop and implement tools for quality monitoring', 'remind clinicians', 'facilitate relay of clinical data to providers' and 'centralise technical assistance'. Studies generally reported strategies' actions, targets, timing, and outcomes, but inconsistently reported strategy actors, dose, and justification.

conclusionGreater specification of implementation strategies to improve the initiation of specialty outpatient mental health care among adults in primary care settings with suicidal thoughts and/or behaviour is needed.