Table 2 Summary of qualitative findings with exemplar quotes and associated codes

Kinds of virtual activities wished for

Online activities

Online workshops that provide information and advice on varying areas of concern related to mental health/wellness. Online chats with peers who are struggling with similar issues.

Activities such as fitness activities, educational activities, fun activities, interactive activities, surveys

Awareness

Bringing awareness and spreading information about resources. Participating in studies like this one.

Various awareness initiatives

Therapy

I would like one-on-one therapy to help me cope when I am in distress.

Counselling or therapy, skills-based, one-on-one therapy, mindfulness or meditation, family therapy

Optimal features

Platform

I think all formats would be beneficial in their own way, e.g., chats are good for people that find it hard to talk, or have a hard time making eye contact. Overall, though, video would seem to best.

Video call, phone, chat or text-based, online, in-person, discussion boards, smaller groups, any format

Technological features

Clear and smooth audio and video, (un) muting audio and (dis) connecting video, option for sharing screens and files.

Smooth audio and video calls, option to share photos or files, convenience and ease, ability to turn off camera, mute button, option to share screens, good internet connection, optimal lighting, good camera quality

Safety features

To be able to have conversations, in private via chat maybe so parents can’t listen in.

Privacy, maintain social distancing, anonymity features for video calls

Care needs

Clear communication and a non-judgmental environment.

Free virtual care for all.

Clear communication, non-judgmental environment, continuity, scheduled check-ups, free services

Administrative

Consistent weekly and/or daily scheduling opportunities available.

Availability of appointment times, easy booking appointment

Reasons for not considering

Preference

I feel like mental health requires assistance in person. A human-to-human contact.

Do not care or feel like it, do not like the format, prefer to be in person

No use for these services

I have done a lot of growing on my own with the help of family and [clinician]. The situation that brought me to [services] has been resolved and I feel like my mental health improved greatly with less worries now.

Already have supports in place, do not currently need them

Discomfort

I would be embarrassed to talk about my issues with people who probably have more serious issues. I feel like I’m pretty privileged and should be able to figure it out.

Hesitant or too anxious to try, not comfortable with online, awkward

Security & privacy concerns

As my family members are in close proximity within the house, I wish to use such services without any disruptions/in my own privacy (without anyone else being within earshot).

Many are afraid of opening up about mental health in the first place. Group discussion virtually would increase anxiety for me because I cannot sense how the group is and what if they are recording what we are saying/others in the room are hearing it. There would be even less confidentiality in my opinion.

Security concerns, privacy issues with living at home, privacy issues in general

Technology

Would rather speak in person if anything. Don’t feel comfortable being online and my internet is also not strong enough to support that.

Poor internet connection

Advantages of virtual services

Convenience and accessibility

Convenience. No need for an app or anything else. I just called my school psychologist, and we got to talking - which helped me a lot. There was nothing complicated about it.

No travel, convenience, uncomplicated, accessible services, flexible scheduling, able to receive care during a pandemic, fast, more inclusive

Comfort

I can avoid the embarrassment of crying in person.

Feeling comfortable with online services, able to express feelings virtually, more comfortable with phone conversations

Practicality

Talking to someone responsible and smart is always helpful. I keep track of the things I do and where I am at during the week and bouncing what I am up to off of a social worker can go along way when it comes to maintaining a healthy pathway.

Good for communication, useful, cost-effective, helped mental health, helpful, ability to read what was previously expressed, showed up to all appointments, worked

Human connection

Being able to see the person I was talking to as opposed to just speaking to them on the phone.

Seeing their faces, sense of community, feeling supported

Safety

Able to get the support I need while staying safe, and while keeping therapist/social workers safe.

Socially distanced, safe, feeling more secure, privacy

Disadvantages of virtual services

Lack of human connection

It’s very impersonal. I can’t connect with the person and I tend to forget what people tell me when talking on the phone.

Less personal (e.g., no human connection), not in-person, feeling inauthentic over phone, feelings of loneliness, less personalized care, longer establishing rapport

Technology

Potential Wi-Fi issues, and it’s hard to find a spot with okay lighting and sound.

Technological limitations, poor internet connection, not always reliable, video use

Privacy, security, safety

In my home, it’s extremely difficult to have a real sense of privacy (no matter which room you’re in someone can here you or is waiting to use it).

Lack of privacy at home, security concerns

Emotional barriers

I kind of quit therapy because I became unmotivated to pick up the phone and my psychiatrist’s office always messes up and doesn’t send me the link to our meeting so those get skipped.

More distractions, harder to focus, forgetful, unmotivated

Discomfort

Sometimes it is more difficult to talk about negative and painful things that have happened over the phone.

Does not feel comfortable, awkward, difficult to discuss painful experiences over phone, unfamiliar

Administrative issues

Not always reliable if professionals are unavailable. Unlikely to receive consistent care since you talk to different people.

Longer time between appointments, unreliable scheduling

Structure

I don’t have to leave the house/get changed/wake up early (I’m completely out of whack; I don’t have a system, I’m not living life as it normally is).

Time consuming, lack of routine

Poor experience

It was super boring, isolating, and I felt like I was a horrible person because of how they treated me.

Did not receive care needed