Care Crisis Research Articles

A unique model of care for youth in crisis: A pilot open trial.

Suicide is the second leading cause of death for those ages 10-24 years in the United States, and emergency department (ED) visits due to youth self-injurious thoughts and behaviors (SITB) and increased substantially between 2016 and 2021. Although ED services are essential for an effective system of care, the ED setting is typically not well-suited for the comprehensive, collaborative, and therapeutic evaluation of SITB; treatment planning; and care coordination that youth in a suicidal crisis need. As a result, an urgent care model for mental health designed to provide comprehensive crisis triage and intervention services is needed within outpatient psychiatry. This pilot trial examined the feasibility, acceptability, and preliminary clinical outcomes of a brief, urgent care model, the Behavioral Health Crisis Care Clinic (CCC), designed to provide comprehensive outpatient triage and intervention services aimed at reducing suicide risk for youth in crisis. Participants were 189 youth (ages 10-20; 62.4% females; 58% Caucasian) who had past-week suicidal ideation or behavior and their caregivers. The results demonstrated the CCC model exceeded feasibility and acceptability benchmarks based on the Service Satisfaction Scale (M score > 3.00). CCC care was associated with significant decreases in self-reported suicide risk based on the Collaborative Assessment and Management of Suicidality Suicide Status Form with low levels of ED usage during CCC care (7.7%) and 1-month posttreatment (11.8%). Over 88% of patients without established outpatient care at the time of referral were connected to care during CCC treatment, almost all of whom (95%) continued with ongoing mental health care 1 month after ending CCC care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The political: A view from Jakarta’s kampungs

This article is a response to Leitner and Sheppard’s recent publications on Jakarta. I argue that Jakarta’s kampungs and the eviction of their communities is a topic that needs to be situated in the realm of social reproduction. The multidimensional problems in kampungs fall within capitalism’s wider ‘crisis of care’. From this methodological position, we can access the political domain of the kampung, from which a new political agency emerges as collective bodies beyond merely the sum of individual survival tactics.

Pop-up micro clinics for pre-exposure prophylaxis of immunocompromised patients

PurposeHealth care systems aspire to adopt integration strategies shifting the focus from acute care to a broader focus on community-based health and social services. Real-world examples demonstrating effective delivery of integrated care are essential.Design/methodology/approachIn this article, we introduce UHN Connected Care Hub, an innovative model of care comprising an interdisciplinary team designing sustainable, shareable practices across the continuum of care alongside community and health organization partnerships.FindingsWe describe UHN Connected Care Hub’s ability to identify patients from high-risk population and collaborate to delivery timely care, in detailing the real world experience of this model of care in the organization of a centralized system of micro-clinics to administer a therapeutic for pre-exposure prophylaxis against COVID-19 (Tixagevimab/cilgavimab [Evusheld]) in a population of immunocompromised patients.Practical implicationsHaving a centralized system of micro-clinics for care delivery presents opportunities for increased adaptability, patient accessibility, enhanced community partnerships and integratedness. Expansion in the scope of services could also create new opportunities in preventative therapies for optimizing the cost effectiveness and quality of health care provided at the population level.Originality/valueThere is limited evidence on how to efficiently deliver integrated care, particularly to vulnerable and co-morbid patients. We discuss how dynamic organizations with proper infrastructure and a network of healthcare partnerships may allow a more fluid response to rapidly changing policies and procedures and facilitate preparedness for future health care crises or pandemics.

Communities of Care Approach: Developing a Place-based Model of Care and Building Partnerships in the Communities in Central Singapore.

The population in Singapore is ageing, adding pressure to community care as the health and social needs of its residents increase. This has accelerated the pace at which Regional Health Systems adopt and deliver its population health strategies from early prevention, chronic disease management, crisis care to end-of-life care. To this end, the Central Health Integrated Care Network (ICN) began its journey to develop Communities of Care (CoCs) with other health and social care partners to meet the needs of residents in the Central Zone of Singapore. This paper describes the processes and steps taken by Central Health ICN to build partnerships with other agencies and organisations to build place-based models of care in the local neighbourhoods. The faciliating factors and the barriers faced in the implementation of CoCs were described to allow sharing of such learnings on large scale change. Strategies in overcoming some of the challenges were also presented to demonstrate the iterative processes required in building integrated place-based models of care to meet the needs of the residents in different communities.

Automating adult social care in the UK: Extracting value from a crisis

The UK appears fixed in perpetual care crisis propelled by austerity-driven funding cuts and the country’s intensifying care labour shortage. Austerity in the UK has generated an operating environment that has accelerated privatisation and incentivized and necessitated private innovation. In this writing, we examine how the infrastructure and delivery of social care in the UK is being radically reimagined through technology. Promising to deliver critical efficiencies and cost savings, new automating technologies are being tested and introduced to reorder how and where care is managed and delivered. Drawing on a series of interviews conducted with local authorities in the UK and the executives of private companies, our task is not to assess the efficacy of new technologies; rather we examine how these public-private partnerships raise difficult questions: Who will deliver caring futures in the UK? Who is absorbing the fiscal risk of technological innovation? Who is profiting? And what are the limits of technology as a response to our care crisis?

Developing a ‘national module’ for nurses considering a career in general practice: addressing the workforce crisis in primary care

The age profile of GPNs means that the pool of experienced GPNs available to recruit is rapidly shrinking. This article looks at potential solutions to the workforce crisis affecting practice nursing If the predicted workforce crisis in primary care is to be avoided, there is a clear need to increase the number of student nurses considering a career in general practice. Initiatives such as the NHS England national module, described here, are integral to this process. Of the HEIs nationally that responded to a tender from NHS England, SHU was one of seven HEIs awarded a contract to deliver the module. The SHU module uses a blended approach to learning and provides learners with an insight into general practice and the role of the general practice nurse. It is unique in that it is delivered in partnership with the South Yorkshire Primary Care Workforce and Training Hub and is designed to create a workforce ‘pipeline’ of new graduate nurses who will be equipped to access a regional career pathway for general practice nurses.

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives.

Mental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched. This study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty-one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in-depth interviews. The findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after-hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers. The findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning-making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis. The first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.

Fictional faces of female suicide: Qualitative analysis of selected Russian-language texts of the school reader

IntroductionIsaiah Berlin’s (1948) exploration of the self-searching of Russian thinkers includes studies of the writers – Tolstoy and others (now – Russian-language texts of the school reader). These studies refute a widespread misconception about the relations between Russian writers and thinkers: namely, that in Russia literature and radical thought form two distinct traditions related only by mutual hostility. The works of Tolstoy, Dostoevsky, Karamzin, Leskov, Ostrovsky, and of minor novelists too, are penetrated with a sense of their own time, of this or that particular social and historical milieu and its ideological content, to an even higher degree than the ‘social’ novels of the west. The personal characteristics of suicide victims, heroines of Russian literature, along with the gender aspects, deserve attention in suicidal behavior (SP) focus.ObjectivesTo study personal characteristics of suicide victims, heroines of fiction.MethodsQualitative analysis of selected Russian-language texts of the school reader.ResultsAt the dawn of literature, we have seen fiery heroines and tremulous victims in the arms of death. Аs psychology approach was developed, and we get acquainted with the tragiс backstory. Psychotypes of suicides are exaggerated and overlapped. «Hysterical»: manipulative, frigid nymphomaniac (e.g., Anna Karenina). «Freedom-loving rebel» (i.e., Katerina reincarnations from A. Ostrovsky) in conditions of excessive regulation. «She-Devil, or Rebel Without a Cause». The obsession with death turns into a criminal and a victim (e.g., «Lady Macbeth of the Mtsensk» by N. Leskov, Turgenev’s Susanna or Klara Milich). The image of a vindictively furious («velvet and tiger claws») woman descends to the Victorian view of female self-will. «Mimosa» is a sensitive, dreamy person, unable to resist the hardships of life, dependent (dies with her beloved, objection). In suicide, the strength of weakness is the outcome of a humiliating life (e.g., Karamzin’s «Poor Liza», «A Gentle Creature» by F. Dostoevsky. The meaning of suicides is the following: a call (to compassion, salvation), a «cry for help», atonement for one’s (imaginary) – someone else’s (by proxy) guilt, and release from encumbrance.ConclusionsFiction and life are united by emotionally unstable characters and/or depression as markers of unsatisfactory resilience. The cultural diversity of gender patterns and interpretations of SP challenges the essentialist view that «femininity» and marriage are protective factors. SP patterns illustrate and complement the explanatory concepts of SP. The inner world of suicidal people is fascinating and contributes to the evidence-based optimism in the «patient-centric» crisis care model.Disclosure of InterestNone Declared

Management of youth with suicidal ideation: Challenges and best practices for emergency departments.

Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

Responsibilization and Retraditionalization: How Neoliberal Logics Reproduce Gender Inequities Among Women Community Organizers in Chicago

Neoliberal capitalism creates a “crisis of care” in which social reproduction—though necessary for society—is undermined by stripping away support for caregivers, who are disproportionately women. “Social reproduction” refers to the reproduction and maintenance of the labor force via childbirth, child rearing, and caregiving for loved ones more generally. This interpretive phenomenological study examines how a crisis of care manifests for women in the workplace. Drawing upon in-depth, semistructured interviews with Chicago-based women who work as community organizers, our findings demonstrate that sexism in the workplace, coupled with the gendering of care work, creates unique difficulties for these women. By integrating the work of feminist critical theorists who argue that neoliberal logics produce gendered impacts, particularly due to processes they call responsibilization and retraditionalization, our findings help explain why and how gender subordination and gendered divisions of labor persist, even in organizations with a professed commitment to social justice.

Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm.

Risk of suicide is increased immediately following emergency department (ED) attendance for self-harm. Evidence suggests that brief psychological interventions delivered in EDs are effective for self-harm. The Assured intervention comprises an enhanced biopsychosocial assessment in the ED, collaborative safety planning and three rapid solution focused follow-up sessions. We addressed the following research questions: What were ED mental health liaison practitioners' and patients' experiences of the Assured intervention? What were the barriers and facilitators? What might the mechanisms be for improving experiences and outcomes? We conducted a feasibility study of the Assured intervention in four EDs in Southeast England. Semi-structured interviews were conducted with 13 practitioners and 27 patients. Interviews were transcribed, coded line-by-line in Nvivo and thematically analysed using an inductive approach. Inter-rater reliability was calculated with a kappa coefficient of 0.744.

State Policies Associated with Availability of Mobile Crisis Teams.

Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.

Phytochemical and in vitro biological profiling of Portulaca grandiflora whole plant extracts

P. grandiflora is a small herbaceous annual herb from Portulacaceae family and found useful in mitigating the health care crisis. The study aimed to determine the phytochemicals and to examine the in vitro antifungal, antibacterial, antioxidant and anticancer potential of Portulaca grandiflora. Crude methanolic, ethanolic and n-Hexane extracts of whole plant were used for this study. Antimicrobial properties were estimated through disk diffusion assay, antioxidant activity was determined by using 2,2-diphenyl-1-picryl-hydrazyl scavenging (DPPH), total antioxidant capability and reducing power assays. From the results it was found that methanolic extract of P. grandiflora showed the highest zone of inhibition against Pseudomonas aeruginosa and Candida albicans i.e. 36 ±1mm and 18 ±1 mm respectively with MIC of 25 μg/ml. The highest amount of gallic acid equivalent phenolic and quercetin equivalent flavonoid content were found in methanolic extract of P. grandiflora i.e. 77 ± 0.68 μg GAE/mg extract and 63 ± 1.08 μg QE/mg extract. The significant DPPH scavenging activity (P< 0.05) wasrecorded for methanolic extract of P. grandiflora (87%). Considerably greater antioxidant capacity (10 ± 1.18 μg AAE/mg) and reducing power (4.06 ± 0.18 μg AAE/mg) was observed in methanolic extract. MTT cell viability assay methanolic extract of P. grandiflora showed the IC50 of 42.70 μg/ml at 72h. Whole plant extracts in different solvents exhibit strong pharmacological properties thus suggesting it as a major source of pharmaceutical industry.

Impact of COVID-19 on the Pediatric Primary Care Model in Catalonia: Analysis of Changes in the Number and Type of Face-to-Face and Remote Visits.

The outbreak of COVID-19 has turned the care model of health systems around the world upside down. The health care crisis has led to opportunities for digital health to deliver quality care, and the system has been redirected toward telemedicine. In Catalonia, Spain, as of March 2020, the pattern of visits in primary care pediatric consultations changed, such that face-to-face visits decreased in favor of non-face-to-face visits. This study aimed to analyze variations in the types of pediatric visits in primary care centers in Catalonia before and after the onset of COVID-19. This was a descriptive observational study based on administrative data. The number and type of visits to primary care pediatric services in Catalonia between January 2019 and December 2022 were studied. A drop of more than 80% in face-to-face visits and an increase of up to 15 times in remote visits were observed as of March 2020 compared to the previous year. Subsequently, the face-to-face attendance rate began to recover, although it did not reach the same rate as before COVID-19. Non-face-to-face visits were maintained, representing more than 20% of the total after more than 2 years of the pandemic. COVID-19 has been the trigger for a transition in the types of visits to primary care pediatric services. The COVID-19 pandemic was a clear catalyst for the integration of telemedicine in Catalan pediatric health care. In this context, although face-to-face consultations have recovered in absolute numbers, after the pandemic period, the weight of telemedicine has increased.

Adaptation of a specialized cardiac centre to patient management and health care services in the midst of the COVID-19 crisis: The Bahrain experience

BackgroundHospitals worldwide had to implement several measures to control SARS-CoV-2 pandemic, particularly in cardiac center. However, the extent to which these adapted measures have been perceived by the nurse care provider as effective needs to be explored in order to identify the most successful measures that can be considered in future health care crises. AimTo explore the adaptation of patient management and cardiac health care services at a specialized cardiac center in the Kingdom of Bahrain during the COVID-19 pandemic. MethodsA cross-sectional study was employed among nurses working at the main cardiac in Bahrain centre using a convenience sampling method along with the Patient Management and Cardiac Health Care Services questionnaire. ResultsA total of 214 nurses were enrolled in the study. Most participants were females (89.3 %) with a mean age of 34.6 ± 7.9 years. The majority of participants have experienced a reduction in the number of hospitalized patients (87.4 %) during the Coronavirus-19 pandemic. According to the participants, smartphone applications were used to overcome face-to-face consultations (52.8–65 %) and the appointments were changed to phone consultations (60.7 %). Outpatient and diagnostic services were the most affected services (95.8 % and 94.4 %, respectively). In contrast, the emergency and critical care units were the least affected services (56.6 % and 30.8 %, respectively), (p ˂ 0.001). ConclusionEssential cardiac services continued to function during the COVID-19 pandemic. However, several diagnostic and outpatient services were disrupted. Thus, there is an urgent need for developing a protocol for care of patients admitted in cardiac center during health crisis times.

Nurse Staffing Task Force: Strategies to Improve Acute and Critical Care Staffing

The purpose of this paper is to describe the process and outcomes of the Nurse Staffing Task Force. This work, which followed the Partners for Nurse Staffing Think Tank, was co-convened by professional organizations to address the staffing crisis in acute and critical care. The volunteer members of the Task Force represented diverse roles in health care and meet over a 9- month period. Their work resulted in an open access publication that is an inclusive representation of their collective expertise.

Refocusing Our Science on the Planetary Health Crisis and Sustainable Cancer Care.

Refocusing Our Science on the Planetary Health Crisis and Sustainable Cancer Care.

The lucky and unlucky daughter: Gender, land inheritance and agrarian change in Ratanakiri, Cambodia

AbstractIn many agrarian societies, women come to own land, and people secure care in old age through land inheritance. The social norms guiding inheritance shape gendered, generational and class‐based relations of power in rural areas, and intra‐family land rights can be lost when inheritance norms shift. In Cambodia's northeastern Ratanakiri province, rapid agrarian change over the past decade—including the expansion of land grabs, cash cropping and Khmer in‐migration—is transforming decision‐making around inheritance. Based on a large sample of qualitative interviews and focus groups carried out in 2016 and 2020 with Indigenous and Khmer communities, we focus on the ways in which intergenerational and gendered obligations of care are being reconfigured as land scarcity and inequalities within rural areas become more pronounced. We argue that social norms around land inheritance are in flux, with a proliferation of diverse practices emerging including a shift from matrilineal to bilateral inheritance amongst some Indigenous families, the deferment of marriage and inheritance decisions due to a lack of land and parents taking on debt to buy land and secure care in older age. These changes are reconfiguring gendered and generational identities in relation to land and have potentially negative consequences for land‐poor families, in particular, for poor Indigenous women. These changes are symptoms of a larger ‘crisis of care’ in rural communities.

HHS approves New Mexico's community‐based care expansion

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services, has approved a proposal from New Mexico for community‐based mobile crisis intervention teams to provide Medicaid crisis services, a cms.gov news release stated. The Feb. 6 announcement is the latest in HHS' ongoing efforts to support President Biden's whole‐of‐government strategy to transform mental health services for all Americans — a key part of the President's Unity Agenda, the news release stated. New Mexico is the 15th state to expand access to community‐based mental health and substance use crisis care through President Biden's American Rescue Plan. With this approval, the state will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year. This work builds on HHS' broader work to expand dramatically the full continuum of mental health crisis services, including through the nationwide launch of the 988 Suicide & Crisis Lifeline and expansion of Certified Community Behavioral Health Clinics under the Bipartisan Safer Communities Act, providing crisis services 24 hours a day, 7 days a week, regardless of a person's ability to pay.

How can we improve mental health crisis services for young people? A survey of mental health crisis professionals across Greater Manchester

BackgroundHealthcare providers have been under pressure to improve the provision of crisis mental health services in England. Through the process of devolution, Greater Manchester has created the Crisis Care Pathway to meet the growing demands on mental health crisis service provision for young people in the city region. At the end of the first funding cycle, this research evaluated the pathway with a focus on potential future improvements.MethodsAn online survey, including a mixture of quantitative, Likert scale items and qualitative, open-ended questions, was completed by 60 professionals working within crisis mental health services for young people in Greater Manchester.ResultsAnalysis of the quantitative data identified 6 clear areas for improvement from the evaluative indicators: delivering support at a time that works for young people; delivering the right amount of help for the right length of time; providing services which are quickly available; services and agencies working together effectively; movement between services; fully integrated services. A further 3 super-ordinate themes were developed through thematic analysis of the qualitative data that indicate areas in need of improvement: The challenge of navigation, issues of accessibility into and between services, and how to improve integration.ConclusionsThis research found 7 clear actions to enhance the provision of crisis mental health services for young people in Greater Manchester, which may be transferable to other mental health crisis service contexts.