Trust in mental health clinicians among patients who access clinical notes online

Objective: This study explored patient perspectives of how online access to clinical notes (OpenNotes) within the Veterans Affairs (VA) health care system may affect patients' relationships with their mental health clinicians. Methods: Semistructured qualitative interviews were conducted with 28 patients receiving VA mental health care who had accessed OpenNotes. Transcripts were coded and analyzed with a constant comparative approach. Results: Respondents consistently reported that patientclinician relationships-feelings of trust in particular-are critical to the therapeutic process and that reading clinical notes strengthens or strains patients' 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.