Table 2.

Theme label, definition, and example quotes from 65 open responses about recommending LITs for patients on treatment waiting lists

Theme	Frequency Mentioned	Definition	Example Quote
Patient appropriateness	27	Factors that affect whether a patient is or is not appropriate for using a LIT while on a treatment waiting list (e.g., need for evaluation, level of risk, diagnosis)	I don’t have time to evaluate what prospective patients might need, and wouldn’t want to recommend resources to them without knowing them better.
Feasibility	20	Aspects that influence the logistics of offering LITs to patients (e.g., time, money, staff, etc.)	It is difficult to recommend something to a client that I have not personally vetted; so the biggest barrier is finding the time to learn about the available resources.
Research evidence and efficacy	18	How effective a LIT would be for patients on a waiting list and the availability of research evidence to support the use of LITs on patient waiting lists.	One problem is the lack of good, evidence-based self-help books for PTSD or trauma. Most of what is out there is pop psychology and has not been tested.
Patient barriers	15	Barriers at the patient level that would prevent providers from recommending LITs for patients on a treatment waiting list (e.g., money, access to resources, literacy level).	For the families I work with, there are financial barriers to purchasing books or apps. Additionally, I work with many children with limited reading and cognitive abilities and many parents for whom English is not their dominant language and may have limited reading abilities
Liability	9	Legal or ethical liability related to LIT use with patients	I am reluctant to provide any clinical care to someone who is not officially my patient. I think that is ethically a little sticky.
Patient personal contact	8	Reference to contact between patients and providers in the context of mental health treatment	Many individuals want an actual person and not interested in materials or apps
Additional resources	11	Alternative resources suggested by providers for patients waiting for treatment (e.g., alternative providers, online resources, relaxation techniques)	It’s important to be able to have a range of things to offer which meet the needs or wants of the client. Sometimes I recommend podcasts or blogs, or free online guided relaxation exercises for example
Positive attitudes	18	Reflections of positive aspects of LITs and their use by patients	Self help books are readily accessible
Trust in programs	6	Attitudes towards LIT programs that reflect a level of or lack of trust (e.g., security, intentions)	I am hesitant to recommend online services [because] I am uncertain about security and setting up vulnerable people to businesses that have nonclinical motives.
Systemic problems	4	Reference to problems at a larger systemic level that influence providers’ attitudes towards or ability to recommend LITs (e.g., working conditions, access to resources)	Though the working conditions and pay are abysmal at best, I am passionate [about] community mental health and am quite frankly tired of seeing my clients and community get the leftovers of the system.
Downplaying distress	2	Concerns around patients feeling dismissed by being offered services that are considered less than their needs require.	My concern in recommending these options is that the caller/would-be client may perceive the recommendations as downplaying the significance of their distress.