I am excited to announce the start of MH-CREST following an intense year of development. The MH-CREST research team is a partnership between The School of Healthcare at the University of Leeds, the University of Sheffield and our sponsor Sheffield Health and Social Care NHS Foundation Trust. Together, the MH-CREST team hold expertise in mental health nursing, lived experience, social and psychological sciences, psychiatry, information science, evidence synthesis, and realist methodology. As a new NIHR Principal Investigator, I have been on the steepest learning curve but so far have survived with the support of my colleagues!
We held our first research team meeting in September and started to tackle some important but tricky questions:
What is a mental health crisis?
Mental health crises can be defined in different ways, but after much discussion, the MH-CREST team decided we would define crisis as:
1. A relapse in a psychiatric condition, characterised by increased symptom severity (such as voice hearing, suicidal thoughts, and other behaviours that could cause harm) and decreases in social functioning (including reduced self-care) (Crompton & Daniel, 2006)
2. A reaction to adverse life events that disrupts the lives of the person and their family because their usual ways of coping have not worked (Tobitt & Kamboj, 2011)
3. An opportunity for change that may enable people to develop new ways of coping (Caplan, 1989)
These definitions have helped us to decide what types of evidence we will include in our project and which stakeholders we should speak to.
What evidence will be included in MH-CREST?
Most UK mental health crisis care is in community settings because hospital care is hard to access, unpopular, and costly for the NHS. There is some evidence that community crisis services in the UK provide value for money and are effective for many people, others report not being able to access services and their needs not being met (Mind, 2011, 2012; CQC, 2015). Before the project started, we consulted people who have accessed mental health crisis services and these sessions suggested that crisis services resemble a tangled web of overlapping services with complex referral routes and blurred functions.
UK crisis services are diverse, vary in different parts of the country and have many different names. They are provided by the voluntary sector, NHS, local authority or social enterprise (a type of business that uses profits to improve people’s lives) and are increasingly delivered as a collaboration between providers.
Following discussion, the MH-CREST research team agreed to focus on crisis care for people who are in a community setting. The people we consulted before the project started also thought that the focus should be on crisis services for people in community settings rather than hospital because community services are generally preferred, provide the respite, information and support that people ask for, and avoid the need to be away from home and family. Crisis care is complex so we will revisit and refine our definitions as the project progresses.
How do crisis care services work, who do they work for, and in what circumstances?
We will review previous research and speak to stakeholders to understand how crisis care services work, for whom and in what circumstances – this type of literature review is called ‘a realist evidence synthesis’ (Pawson et al., 2005). We will start by developing informed hunches (‘programme theories’) about how crisis services are supposed to work by reading journals, books, policy documents and talking to stakeholders with expertise as health professionals, service users, family members, commissioners, policy makers and academics.
Once we have identified programme theories about how crisis services are supposed to work, we will test them by re-examining previous research and consulting stakeholders. We may also be able to link what we find to broader (middle range) theories that help us to explain how crisis services work (or don’t work). In a final step, we will work in partnership with the stakeholders to write ‘pen portrait’ examples that connect our theories to peoples’ lived experiences.
Why is the project important and what will it do?
UK mental health crisis services have had investment for some time and important research has been published, but there are still gaps in our understanding. We already know from research findings and from listening to the experiences of people using services, that crisis care outcomes vary in different contexts and people find it hard to access the right help when they need it. For example:
- in some parts of the UK, crisis services are not available 24 hours
- people who are black or belong to a minority ethnic group (BAME) find it hard to access crisis care that meets their needs
This project will explain why outcomes vary across different services designs and providers and identify what is needed to simplify the pathways through crisis care, improve access and reduce variability. Using this information, health services commissioners will be able to design crisis care based on what leads to the best outcomes for people experiencing a mental health crisis wherever they live enabling them to access the right crisis care at the right time.
Nicola Clibbens is a Lecturer in Mental Health at the University of Leeds. To find out more about the MH-CREST project click here and here or contact Nicola. Follow Nicola and the MH-CREST project on Twitter @UniLeedsMH using the hashtag #MHCrest.
This study is funded by the National Institute for Health Research (NIHR) HS&DR programme (NIHR127709). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Caplan, G. (1989) Recent developments in crisis interventions and the promotion of support services, Journal of Primary Prevention, 10, 1, 3-25.
Crompton, N., & Daniel, D. (2006) Guidance statement on fidelity and best practice for crisis services. London, Department of Health, NHS National Institute for Mental Health in England, Care Services Improvement Partnership, London.
Mind (2011) Listening to experience: An independent inquiry into acute and crisis care, Mind, London.
Mind (2012) Mental Health Crisis Care: A briefing for clinical commissioning groups, Mind, London.
Pawson, R., Greenhalgh, T., Harvey, G. & Walshe, K. (2005) Realist review: a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy, 10, 21-34.
The Care Quality Commission (2015) Right here, right now: People’s experiences of help, care and support during a mental health crisis, CQC, London.
Tobitt, S. & Kamboj, S. (2011) Crisis resolution/home treatment team workers’ understanding of the concept of crisis, Social Psychiatry and Psychiatric Epidemiology, 46, 671-683.