scholarly journals The contribution of the voluntary sector to mental health crisis care: a mixed-methods study

2020 ◽  
Vol 8 (29) ◽  
pp. 1-200 ◽  
Author(s):  
Karen Newbigging ◽  
James Rees ◽  
Rebecca Ince ◽  
John Mohan ◽  
Doreen Joseph ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Case Studies ◽  
Voluntary Sector ◽  
Service Users ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Biographical Disruption ◽  
Sector Organisation ◽  
Crisis Care

Background Weaknesses in the provision of mental health crisis support are evident and improvements that include voluntary sector provision are promoted. There is a lack of evidence regarding the contribution of the voluntary sector and how this might be used to the best effect in mental health crisis care. Aim To investigate the contribution of voluntary sector organisations to mental health crisis care in England. Design Multimethod sequential design with a comparative case study. Setting England, with four case studies in North England, East England, the Midlands and London. Method The method included a scoping literature review, a national survey of 1612 voluntary sector organisations, interviews with 27 national stakeholders and detailed mapping of the voluntary sector organisation provision in two regions (the north and south of England) to develop a taxonomy of voluntary sector organisations and to select four case studies. The case studies examined voluntary sector organisation crisis care provision as a system through interviews with local stakeholders (n = 73), eight focus groups with service users and carers and, at an individual level, narrative interviews with service users (n = 47) and carers (n = 12) to understand their crisis experience and service journey. There was extensive patient and public involvement in the study, including service users as co-researchers, to ensure validity. This affected the conduct of the study and the interpretation of the findings. The quality and the impact of the involvement was evaluated and commended. Main findings A mental health crisis is considered a biographical disruption. Voluntary sector organisations can make an important contribution, characterised by a socially oriented and relational approach. Five types of relevant voluntary sector organisations were identified: (1) crisis-specific, (2) general mental health, (3) population-focused, (4) life-event-focused and (5) general social and community voluntary sector organisations. These voluntary sector organisations provide a range of support and have specific expertise. The availability and access to voluntary sector organisations varies and inequalities were evident for rural communities; black, Asian and minority ethnic communities; people who use substances; and people who identified as having a personality disorder. There was little evidence of well-developed crisis systems, with an underdeveloped approach to prevention and a lack of ongoing support. Limitations The survey response was low, reflecting the nature of voluntary sector organisations and demands on their time. This was a descriptive study, so evaluating outcomes from voluntary sector organisation support was beyond the scope of the study. Conclusions The current policy discourse frames a mental health crisis as an urgent event. Viewing a mental health crisis as a biographical disruption would better enable a wide range of contributory factors to be considered and addressed. Voluntary sector organisations have a distinctive and important role to play. The breadth of this contribution needs to be acknowledged and its role as an accessible alternative to inpatient provision prioritised. Future work A whole-system approach to mental health crisis provision is needed. The NHS, local authorities and the voluntary sector should establish how to effectively collaborate to meet the local population’s needs and to ensure the sustainability of the voluntary sector. Service users and carers from all communities need to be central to this. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 29. See the NIHR Journals Library website for further project information.

scholarly journals Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e019238 ◽  
Author(s):  
Karen Newbigging ◽  
John Mohan ◽  
James Rees ◽  
Jenny Harlock ◽  
Alex Davis
Keyword(s):  
Mental Health ◽  
National Survey ◽  
Local Authority ◽  
Voluntary Sector ◽  
Ethical Review ◽  
Service Users ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Crisis Care ◽  
The Impact

IntroductionTimely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this.Methods and analysisThe study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact.Ethics and disseminationThe University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16–1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice.

scholarly journals Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study

2021 ◽  
Vol 9 (18) ◽  
pp. 1-122
Author(s):  
David Osborn ◽  
Danielle Lamb ◽  
Alastair Canaway ◽  
Michael Davidson ◽  
Graziella Favarato ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Well Being ◽  
Service Users ◽  
Mental Health Crisis ◽  
Work Package ◽  
Crisis Resolution ◽  
Data Set ◽  
Health Crisis ◽  
Crisis Resolution Teams

Background For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units. Design Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout. Setting and participants Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England. Results Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15). Limitations In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data. Conclusions Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.

scholarly journals Mental health crisis resolution teams and crisis care systems in England: a national survey

2018 ◽  
Vol 42 (4) ◽  
pp. 146-151 ◽  
Author(s):  
Brynmor Lloyd-Evans ◽  
Danielle Lamb ◽  
Joseph Barnby ◽  
Michelle Eskinazi ◽  
Amelia Turner ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
National Survey ◽  
Online Survey ◽  
Service Improvement ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Health Crisis ◽  
Crisis Resolution Teams ◽  
Crisis Care

Aims and methodA national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey.ResultsNinety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.Clinical implicationsA national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.Declaration of interestNone.

scholarly journals MENTAL HEALTH SERVICES DURING THE PANDEMIC: THE EXPERIENCES OF LITHUANIAN PSYCHOLOGISTS

2021 ◽  
Vol 7 ◽  
pp. 217-229
Author(s):  
Rita Vaičekauskaitė ◽  
Jurgita Babarskienė ◽  
Jūratė Grubliauskienė
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Computer Literacy ◽  
Help Seeking ◽  
Qualitative Content Analysis ◽  
Self Care ◽  
Vulnerable Groups ◽  
Mental Health Crisis ◽  
Health Crisis

With the COVID-19 pandemic and its restrictions, many countries face an unprecedented mental health crisis, which is being addressed in various ways, including the use of remote mental health services. Lithuania faced two quarantines: in March-June of 2020 and starting November 2020 up to Spring of 2021.  The aim of this study is to explore the experiences of Lithuanian psychologists providing mental health services during the pandemic.  Using the qualitative content analysis method, the following categories were made: from shock to discovery of new opportunities (differences in two lockdowns, better accessibility of services, help-seeking during the pandemic, and the importance of self-care) and contextual challenges (confidentiality, computer literacy, and blurred home/work boundaries). Implications for addressing psychological service issues are discussed, with an emphasis on self-care, setting boundaries, and finding new ways to enhance mental health via mediated communication as well as to reach out to vulnerable groups.

scholarly journals Typology of psychiatric emergency services in the United Kingdom: a narrative literature review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Opeyemi Odejimi ◽  
Dhruba Bagchi ◽  
George Tadros
Keyword(s):  
Mental Health ◽  
Emergency Service ◽  
Psychiatric Emergency ◽  
Service Users ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
The United Kingdom ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
The Uk

Abstract Background Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 h. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UK. Method Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 h. Excluded studies did not describe a PES, non-English, and were not conducted in UK. Results Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. Conclusion All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.

scholarly journals Psychiatric liaison referrals: a thematic analysis during peak COVID-19

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S294-S294
Author(s):  
Kaj Svedberg ◽  
William Hancox ◽  
Hugh Grant-Peterkin
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Careful Consideration ◽  
University Hospital ◽  
Medical Attention ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Low Mood ◽  
Crisis Care

AimsWith the advent of the COVID-19 Pandemic the NHS long term Plan commitments of January 2019 to improve crisis care nationwide became all the more pressing. The aim of this study was to thematically investigate what mental health crisis presentations might be diverted from the Emergency department to external crisis hubs in order to reduce the COVID-19 contamination risks.MethodAll referrals made to the Homerton University Hospital (HUH) mental health liaison service were looked at between 1/3/20-11/6/20 (n = 846), coinciding with the first peak of the COVID-19 Pandemic.Referral data was anonymised and sorted independently into naturally emerging thematic classes by two junior liaison doctors.Cases that did not clearly fit any of the 14 themes generated were further looked into to determine outcome of referral and discussed to try and match to an appropriate class.Result14 frequent themes for mental health crisis referrals were identified. The distribution of these ranged from most common (suicidality) to neurocognitive presentation and identified shifts in themes over the course of the pandemic peak such as increases of low mood, anxiety and intoxication requiring medical attention over the three month period.ConclusionAlthough themes for presentations may be identified in acute referrals to mental health liaison services it is problematic determining how these may be parsed safely to crisis hubs without risking overlooking cases that may require medical attention. The most common theme that was identified and remained throughout the first wave of the COVID-19 Pandemic was acute suicidal presentation. The remaining themes would require careful consideration around risk thresholds for what a service may wish to accept in devolving the emergency department liaison and balance these against future risks of repeat COVID-19 waves.

scholarly journals Acute Day Units for mental health crises: A qualitative study of service user and staff views and experiences

2020 ◽  
Author(s):  
Nicola Morant ◽  
Michael Davidson ◽  
Jane Wackett ◽  
Danielle Lamb ◽  
Vanessa Pinfold ◽  
...  
Keyword(s):  
Mental Health ◽  
Qualitative Study ◽  
Acute Care ◽  
User Satisfaction ◽  
Service Users ◽  
Mental Health Crisis ◽  
Structured Interviews ◽  
Short Term Treatment ◽  
Health Crisis ◽  
Care Systems

AbstractBackgroundAcute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs.MethodsWe conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis.ResultsBoth service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within a ‘safe’ environment. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems.ConclusionsMulti-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice within local acute care systems.

scholarly journals Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis (Preprint)

2020 ◽  
Author(s):  
Natasha Chilman ◽  
Nicola Morant ◽  
Brynmor Lloyd-Evans ◽  
Jane Wackett ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Focus Groups ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Health Crisis ◽  
Face To Face ◽  
Rapid Access ◽  
Qualitative Interview Study

BACKGROUND Analyzing Twitter posts enables rapid access to how issues and experiences are socially shared and constructed among communities of health service users and providers, in ways that traditional qualitative methods may not. OBJECTIVE To enrich the understanding of mental health crisis care in the United Kingdom, this study explores views on crisis resolution teams (CRTs) expressed on Twitter. We aim to identify the similarities and differences among views expressed on Twitter compared with interviews and focus groups. METHODS We used Twitter’s advanced search function to retrieve public tweets on CRTs. A thematic analysis was conducted on 500 randomly selected tweets. The principles of refutational synthesis were applied to compare themes with those identified in a multicenter qualitative interview study. RESULTS The most popular hashtag identified was <i>#CrisisTeamFail</i>, where posts were principally related to poor quality of care and access, particularly for people given a <i>personality disorder</i> diagnosis. Posts about CRTs giving unhelpful self-management advice were common, as were tweets about resource strains on mental health services. This was not identified in the research interviews. Although each source yielded unique themes, there were some overlaps with themes identified via interviews and focus groups, including the importance of rapid access to care. Views expressed on Twitter were generally more critical than those obtained via face-to-face methods. CONCLUSIONS Traditional qualitative studies may underrepresent the views of more critical stakeholders by collecting data from participants accessed via mental health services. Research on social media content can complement traditional or face-to-face methods and ensure that a broad spectrum of viewpoints can inform service development and policy. CLINICALTRIAL

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