MH-CREST: How do community crisis care services work, who do they work for, and in what circumstances?

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!

Nicola has been on a steep learning curve

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.

map of crisis services developed with stakeholders

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.

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.

some of the different names for crisis services in the UK

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.

References

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.

“You don’t need to fight any battle alone – someone is ALWAYS there to support you while you’re fighting whatever battle you’re up against!” #Strongertogether

After many years of wanting to work within the Mental Health field, in September 2018, I finally enrolled at the University of Leeds, to study Mental Health Nursing. As I have been coming up to the end of my first year, I have been feeling more passionate than ever about wanting to raise as much awareness as possible around mental health and to raise money for a charity that I hold close to my heart… – so I could really end this academic year with a *BANG* !!! I sadly had to give up my position as a listening volunteer on the crisis hotlines with the Samaritans due to my study commitments, however this spurred me on to continue supporting them and to help make a difference in other ways. I am such an advocate for the Samaritans after volunteering with the them, as it really opened my eyes to the incredible support they offer. They will;

 “never tell you what to do, they are there to listen, with no judgement, no pressure, and they will help you work through what’s on your mind, for anyone who needs someone, 365 days a year, 24 hours a day. If you need any kind of emotional support, call or text them free from any phone 116 123, or email jo@samaritans.org”. (https://www.samaritans.org/).

So, this is the exact message that I wanted to promote;

 “You don’t need to fight any battle alone – someone is ALWAYS there to support you while you’re fighting whatever battle you’re up against”… especially when you think that they’re not.

Around 1 in 4 people will experience a mental health problem, yet the shame and silence can be as bad as the mental health problem itself – so it is so important to raise this awareness and for us to break this stigma. Since learning about mental health more and more at University, this is the message that I want people who are suffering with their mental health to hear, because we are always stronger together. I want to give a voice and fight the fight for the people who are struggling.

As mental health is not always something that you can see, this is something that I wanted to visibly portray as part of my campaign with images, to strengthen my message. Just because it can’t be seen,doesn’t mean that it’s not there, or that someone isn’t struggling. Someone with a mental illness can lead a full life, BUT may hide their suffering behind a mask and pretend that everything is okay. The photoshoot was done with help from two of my peers. The images of me with half of my face representing someone who on the surface appears well, and the other half of my face with hard hitting mental health messages; “depression, anxiety, panic, manic, suicidal, anger, trauma, low, self harm, shame and stigma”,  represent what may actually lie beneath. My campaign photos led to, my donations  doubling in less than half a day. My target was to raise £300, I am so grateful for all the donations and moral support that I have received throughout my journey; and I have raised 375% of target, which is currently at over £1300 for the Samaritans Leeds.

So to completely push myself out my comfort zone, to give myself a challenge where I would need to use every strength and courage to deliver this message, I signed up to do a Charity Boxing Fight with White Collar Fighter (https://www.whitecollarfighter.com). I committed myself to an 8-week training camp, set up a fundraising page in the hope that the more support and sponsors I received, the more it would encourage me to train harder, and make it more worthwhile going black and blue on my Fight Night. My fight took place on 3rd August, 2019 at the John Charles Centre, Leeds. I had never done anything like this before, no combat sports, no fighting, I had never punched anyone or anything before in my life, so getting in a boxing ring to fight a real human opponent was a real scary challenge for me, but a perfect way to raise some money.

With my boxing journey now over, days later, I may have come out the other side in one piece, but I still haven’t quite processed everything, and I am still shaken up and emotional from it all. I genuinely never prepared myself for how mentally challenging this journey would be for me, and I don’t think that anything can EVER prepare you enough for that fight. Admittedly, I never anticipated the intensity of getting into that ring, literally being face on with your fear… and hand on heart, just how important it really was to have all that support around me – to remind me that even though it was just me and my opponent in that ring, that at no point was I ever fighting my battle alone. I think that’s why I am still so overwhelmed, because I can’t quite believe the amount of moral support I have had, from my incredible family and friends, but even from total strangers, it has been truly amazing.

After round 2, I was ready to give up, I was struggling to keep myself going , but my coach was right when he said to remember “why” I was doing it, what I was doing it all for; and hearing the support from my family and friends cheering me on at the ringside also really kept me going. It was undoubtedly the hardest 6 minutes of my life, and the most overwhelming feeling isn’t that I won my fight – it’s being reminded that there are unbelievable people who have always got my back, and there will always be someone who has got yours. Thank you to everyone who was fighting with me. You never know what someone is going through, or what lies beneath – so always be there for others, because we are stronger together. And be kind, especially to yourself.

If you would still like to donate, please check out my page: https://uk.virginmoneygiving.com/SarahDesjardins.

#mentalhealthawareness#mentalhealth#mentalhealthadvocate#mentalhealthstudentnurse#breakthestigma#samaritans#keepfighting#endthesilence#support#courage#mentalwellness#strongertogether