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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.

A "Hope Box" is a therapeutic tool employed by clinicians with patients who are having difficulty coping with negative thoughts and stress, including patients who may be at risk of suicide or nonsuicidal self-harm. We conducted a proof-of-concept test of a "Virtual" Hope Box (VHB)-a smartphone app that delivers patient-tailored coping tools. Compared with a conventional hope box integrated into VA behavioral health treatment, high-risk patients and their clinicians used the VHB more regularly and found the VHB beneficial, useful, easy to set up, and said they were likely to use the VHB in the future and recommend the VHB to peers.

BackgroundAs part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings.ObjectiveThe aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care.MethodsWe conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process.ResultsOpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes.ConclusionsOur findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation.

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If patient-centered care is to be practiced fully in mental health settings, healthcare institutions need to develop multimodal strategies to enhance clinician-clinician and clinician-patient collaborations to promote and support a focus on discovery and shared accountability for outcomes.

Opponents of abortion in the United States have long made strategic comparisons between abortion and slavery to advance their movement. Within the past two decades, a White‐led branch of the American “pro‐life” movement began invoking racial categories and movements for racial justice to advocate for the socio‐legal recognition of frozen embryos as persons. Extending from ethnographic research with proponents of “embryo personhood,” this article examines three examples of personhood advocacy—a lawsuit, promotional video, and legislative bill—that instrumentalize race through strategic comparisons between embryos and Black Americans, and personhood advocates and racial justice leaders. More than misleading comparisons, invoking race in personhood advocacy underscores this radical movement's threat to reproductive and racial justice. Antiabortion politics of recognition present another durable link between racial and reproductive politics in the United States.