Crisis Point Research Articles

Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited? Working with police forces to improve mental health crisis care for young people.

The last few years have seen a mental health crisis for children and young people in the UK, with more young people presenting to services at crisis point. Young people have reported that there is a general lack of support before reaching the point of crisis and police forces in the UK have seen a rise in callouts related to youth mental health problems. We provide an overview of the evidence for joint responses from police and mental health services and highlight the importance of including people with lived experience in the development of crisis services. Most of the available data relates to interventions for adults, with very few studies including children and young people. We outline a new study in the UK aiming to evaluate a joint response for young people experiencing a mental health crisis. Whilst resources for children and young people's crisis services remain limited, joint response models with police forces can help to provide much needed intervention.

Gudu-Guduwa: Healing Disconnection Through Incorporating Bush and Animal-Assisted Therapies Into Therapeutic Practice: A First Nations Reflection

As mental health therapists, too often we see outward symptoms of lives impacted by complex trauma. Disconnection from self, others (families and community), and Country is at a crisis point. Looking to our First Nations healing knowledges, the author explores her experiences as a First Nations woman and therapist, and how she incorporates bush and animal assisted therapies into her private practice. Areas that the article touches on include healing on your ancestral Country, healing on Country that is not your own, healing when you do not know where your Country is, and incorporating animal assisted therapies into your healing modalities.

Porosity on the Thailand-Myanmar border: before and after Myanmar’s 2021 coup

ABSTRACT Points of political crisis in Myanmar’s history have been the catalyst for forced migration, and the Thailand-Myanmar border has, for decades, been a site of significant border-crossing. But while tens of thousands arrived in Thailand in the aftermath of previous crackdowns by Myanmar’s military, the severity of the February 2021 coup has not been met with a commensurate increase in arrivals. What explains the difference? Over time, the border is demonstrating differential porosity. In this article I theorise the physical, political and social elements that shape border porosity and locate spaces where informality resides within these elements. I liken porosity to a circuit board that stretches deeply into stakeholder states, with dimmers or switches that control the porosity of the border. I examine the case of the Thailand-Myanmar border pre- and post-coup and find that the ability of local actors to exercise discretion in heeding government policy diminished over time. This decrease in informality conditioned the porosity of the border. Part geography, part policy, and part informal social construction, the concept of porosity focuses on the journey, responds to a call for radically decentring the migration governance literature, and helps to uncover the troubled possibilities that border-crossers and potential border-crossers face.

‘Hope’ is the thing with feathers: Student midwifery outside the system

Midwifery in Australia, and across other high-income countries with Westernised care arrangements, is reaching crisis point; an overrun, overworked, and underfunded maternity system causing traumatised and disenfranchised midwives to leave the profession in droves. However, there is also an underreported student midwife retention crisis negatively affecting the profession. Student midwives, becoming disempowered and disillusioned after facing the climate of collective trauma within the system, are leaving their studies at unprecedented rates. The literature explores a number of tangible reasons for this attrition. However, Emily Dickinson's “Hope – the thing with feathers, That perches in the soul, And sings the tune without the words, And never stops – At all.” may be a groundbreaking protective element in the retention of student midwives not only through their studies but also for long and prosperous careers. Hope is more pervasive than resilience, more substantial than tenacity, and more empowering than any other incentives. Hope hides in the relational aspects of midwifery, in women transitioning from maidenhood to motherhood in their power. Exposure to midwifery outside the system, may help student midwives find “the thing with feathers” and reinvigorate their egalitarianism, support their professional philosophy, and ultimately retain them through their studies and beyond.

Exploring the Pathways to Diagnosis for Men With Borderline Personality Disorder: A Qualitative Study.

Borderline personality disorder (BPD) is often perceived as being more common in females, since women are more likely to seek help and be diagnosed. However, epidemiological studies have reported no sex differences in community prevalence. The purpose of this study was to learn from the narrative journeys of men who have received a diagnosis of BPD. Eight men participated, mean age 45.9 years (range 27-73 years). Recruitment was through clinician referrals at the study site and via social media and website advertising. Participants consented to a 60-90-min semi-structured interview via an audio-visual digital platform. Audio recordings were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three themes were identified: (i) The Emergence of Symptoms, (ii) Reaching Crisis Point and (iii) Receiving a Diagnosis. Participants reported many adverse experiences during childhood and adolescence. Early symptoms were often exacerbated by emotionally invalidating caregiving. Participants reported seeking mental health support only after reaching a crisis point, which often arose following an employment-related stressor. Participants typically initiated help-seeking by consulting a General Practitioner. Long delays were reported from initial help-seeking to being diagnosed with BPD; all expressed relief upon diagnosis. The findings highlight the deleterious consequences of emotional invalidation in participants' mental health and their capacity to access timely support. General Practitioners play a critical role in identifying probable symptoms of BPD in men and are the gateway to referral to psychiatrists and psychologists. It is vital that education is provided to assist their important work.

Humanist Anecdotes in Hard Times: F. C. Weiskopf and Lenka Reinerová

This article examines humanist anecdotes about the turbulent times of the mid-twentieth century by F. C. Weiskopf and Lenka Reinerová. It provides a comparative reading of Weiskopf’s Elend und Größe unserer Tage. Anekdoten 1933–1947 (1950) and Reinerová’s “Tragischer Irrtum und richtige Diagnose” (published in Mandelduft, 1998). The anecdotal form of these texts harks back to the popular Enlightenment (Volksaufklärung) anecdotes of Heinrich von Kleist and Johann Peter Hebel, published in 1810–1811 during the Napoleonic Wars. The anecdote as a literary form is particularly well suited to the representation of wartime and political repression. While Weiskopf’s anecdotes explore cruelty and heroism under the Nazi dictatorship, Reinerová’s autobiographical text juxtaposes crisis points in her own life—her time as a political prisoner in France in 1939 and in Czechoslovakia in 1952–1953; her return to Prague as her family’s sole survivor; and her periodic cancer treatment from 1948 onwards. Reinerová describes how the kindness of ordinary people, and her own optimism and resilience, helped her through the worst times. Her lived experience gives her authority as a storyteller in Walter Benjamin’s sense. Both authors contrast human extremes—the good and the bad—yet both remain optimistic about the human capacity for good.

Preventing suicide: a call to action.

The public health approach to suicide prevention requires us to move away from thinking about suicide as a purely clinical problem and to pay heed to the array of social determinants (such as financial hardship or domestic violence and abuse) that might lead people to consider suicide as an option. Clinical factors are important, and, indeed, clinical or indicated interventions are entirely appropriate for people who have reached a point of crisis and should be a mainstay of national suicide prevention strategies. However, our Series stresses the need for selective and universal interventions that tackle the pervasive problem of suicide in a more upstream way, preventing people reaching a crisis point. Many social determinants can best be addressed by sectors outside health, so we are calling for a whole-of-government commitment to suicide prevention. We make recommendations for actions in the areas of policy, practice, research, and advocacy. People with lived experience of suicide should have genuine involvement in all of these actions.

Bifurcations and mixed mode oscillations in a bi-stable plasma model with slow parametric excitation.

In this study, considering a bi-stable plasma model with slow parametric excitation, the bifurcation of periodic and chaotic responses as well as the resulting fast-slow motions is discussed analytically and numerically. For a nonautonomous fast sub-system, the generalized harmonic balancing method is utilized to obtain an averaged system. Bifurcation analysis about the averaged system shows that the critical manifolds form a S-shape structure. Meanwhile, supercritical and subcritical period doubling (PD) occurs on the upper branch simultaneously. As the frequency of the external excitation changes, bifurcation points on the limit cycle manifolds can present different relative locations. Moreover, an additional bi-stable structure induced by Cusp bifurcation emanates from the upper branch. On the other hand, the existence of a chaotic attractor and the corresponding boundary crisis phenomenon are verified using the Melnikov method and the basin of attraction. The structures of the numerical bifurcation diagram show good agreements with the analytical results. Considering two cases of low-frequency excitation, the corresponding fast-slow dynamics are discussed. It is found that, when the fast-slow flow passing the subcritical PD point, a low frequency with different magnitudes will lead to two patterns of bifurcation delay, i.e., the typical one and the excessive delay, which suppress the PD. As for the boundary crisis point, the slow passage effects show no distinct influence. Thus, three transition mechanisms based on two cases of the bifurcation structure are explained, including "fold of cycle-fold of cycle" type, "fold of cycle-delayed subcritical PD" type, and "fold of cycle-boundary crisis" type.

Dementia care coordinators in primary care: a realist evaluation.

A dementia care coordinator (DCC) service has recently been implemented across Kent and Medway Integrated Care Board (ICB). DCCs are provided at the primary care network (PCN) level and work closely with GP practice teams. The service is intended to help service users navigate the care system and provide proactive support to mitigate crisis points. However, the value of this service from key stakeholder perspectives is not yet known. To understand: 1) how the DCC service works, for whom, and in what circumstances; and 2) identify outcomes, resource implications, and costs. The study uses mixed-methods realist evaluation with an embedded economic component. Data collection includes: questionnaires, service provider metrics, and qualitative interviews with healthcare practitioners and service users. Interpretive comparative analysis and narrative synthesis including evaluation of service costs against outcomes will produce a refined final programme theory. Patient and public involvement have been consulted throughout. Preliminary results indicate that when embedded in a local practice, healthcare practitioners including GPs welcome DCC involvement. DCCs act as community lynchpins, bridging service users to appropriate care pathways. The service may be capable of increasing diagnosis rates and reducing crisis points. However, caseloads are currently untamed. Therefore, the service and its workforce are becoming over-stretched. This evaluation describes preliminary findings from a recently implemented DCC service in Kent and Medway ICB. There is a crucial need to enhance the support of this workforce in order to ensure sustainability of this service. These findings will inform service development and future investment decisions.

Critical supply chains and Australian maritime training requirements

The Offshore and Specialist Ships Australia paper has focussed on two of the program themes being: access to the right skills including STEM, with STEM being a critical part of both Deck and Engineer Officer training and improving and securing supply chain connectivity. We see these two items are critical elements for the Maritime requirements of the Offshore sector for Oil and Gas export plus both construction and demobilisation of offshore facilities, pilotage of vessels and the requirement of internal maritime knowledge within organisations. The focus on this document will be twofold: Firstly, the current critical lack of qualified deck and engineer officers and how this can be rectified. The lack of domestic training has recently been identified by both Maritime Industry Australia Ltd and Australian Resources & Energy Employer Association as being at a crisis point. Secondly, the lack of an Australian strategic fleet (including a viable Australian International Shipping Register (AISR)) and the consequent vulnerability of our critical maritime export and import supply chains. We believe that both these theme items are mutually dependent and are in urgent need of the attention of both the wider energy export industry and Federal and State Governments.

Financial Inclusion of Female Social Commerce Entrepreneurs in Light of the Lebanese Economic, Financial, and Sanitary Crisis

Social commerce in Lebanon is on the rise in light of the sanitary, financial, and economic crisis that the country has been facing. Female entrepreneurs are increasingly investing in this informal market. This paper aims to study whether social commerce, in a turbulent context, paves the way for more financially included women. Female social commerce entrepreneurs have been asked to fill a survey about their financial behavior before and after the pivotal point of the Lebanese crisis, on October 17, 2019. Results show that social commerce in Lebanon is mainly cash-based. Nonetheless, a remarkable number admitted using some banking products and services prior to the pivotal point of the crisis, in October 2019. Overall, this article shows that social commerce affects some aspects of female entrepreneurs’ financial inclusion; but the Lebanese triple crisis that has struck the core of the banking system has slowed the financial inclusion process down, possibly reversing it to a financial aversion

Describing the development and implementation of a novel collaborative multidisciplinary approach to deliver foot health supports for individuals experiencing homelessness and its outcomes.

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.

Confronting Conundrums of Care in College Student Advising

At colleges and universities throughout the United States, academic advisors play a central role in stemming the tide of declining student enrollment and academic underachievement—especially in the wake of academic, physical, emotional, and interpersonal setbacks incurred during the COVID-19 pandemic. For many undergraduates, the mentoring relationship with their academic advisor provides the longest lasting and deepest connection with a faculty or staff member throughout their college experience. Increasingly, the expectations that institutions and students place on academic advisors have escalated far beyond simply guiding course selection and checking fulfillment of graduation requirements. While this more holistic approach to advising can cultivate a greater sense of belonging, it also places the advisors in a precarious position as the parameters of their responsibilities and the extent of caregiving continue to broaden. The ever-expanding expectations of caregiving placed on college academic advisors exemplify how pandemic-informed labor practices across many workplaces inadequately acknowledge caregivers while the care recipients may become overly dependent. This study investigates how advising evolves to become an extrapolation of the caregiving demands socially placed upon women in traditional, patriarchally structured families and workplaces. Using methods derived from critical incident theory that identify systemic crisis points and opportunities for intervention, the authors examine narratives of two women who serve as the lead advisors for their departments in southeastern United States universities. Their narratives delineate two double binds. First, the presumably bottomless reservoir of care demanded from women places nurturance of students in tension with career advancement and other care responsibilities (e.g., self and family). Second, setting boundaries to caregiving may generate accusations of insensitivity, but boundless care can accommodate and encourage learned helplessness among students. The investigation concludes with suggestions to reform institutional policies and build student resilience that equips them to learn independently.

Links Between Midwives and Student Midwives’ Mental Health

There is an overwhelming prevalence of mental health struggles for midwives and midwifery students in the current workforce.1 Most concerning is the fact that these struggles are becoming the norm for midwives.1 The retention rate of midwives is at a crisis point.2 In 2022, there was an estimated shortage of 2,000 midwives in England.3 The number of midwives on antidepressants and anxiety medication continues to rise.1 Relying on these chemical mood enhancers just to get through the day can feel dehumanising.4

Enhanced supportive care.

Enhanced supportive care is a care model providing earlier access to multiprofessional, coordinated care for patients from the point of cancer diagnosis. As a proactive model of care, it stands as a contrast to providing access to a multidisciplinary team once a patient has hit a crisis point, or when their prognosis has become sufficiently poor that they are able to access traditional end-of-life services. Its arrival in the UK through palliative care teams working in cancer care has led to enhanced supportive care being synonymous with early palliative care. While enhanced supportive care has enabled early palliative care, as it has become more embedded in the UK, it has taken on a wider remit for patients living longer with cancer and the management of side effects. Enhanced supportive care services have also begun to provide care for cancer survivors. Enhanced supportive care services have a key role in modern cancer care in maintaining and improving patients' quality of life alongside cancer treatment and ensuring that patients' priorities and preferences for treatment are considered. Furthermore, enhanced supportive care has been shown to support the wider healthcare system by creating capacity within the NHS, reducing demand on hospital services and saving money. As enhanced supportive care services continue to grow and venture into the care and support of cancer survivors and those receiving potentially curative treatments, ongoing work is needed to determine how these services can be made available throughout the NHS and how a shared vision of the way enhanced supportive care operates can be realised.

Why isn’t flow flowing? Metatheoretical issues in explanations of flow

A flow state describes intrinsically rewarding experiences of complete absorption in a task. While descriptive accounts of flow have gained prominence in “popular” psychology, scientific research has reached a crisis point due to perceived limitations of current theoretical explanations for the experience. Here, we evaluate key metatheoretical frameworks underpinning previous explanations of flow and situate the need for reconsidering the ontological status of flow experiences and the causal entailments that might be needed to explain them. We consider the possibility that the subject–object dualism implied, and the organismic asymmetry apparent in prevalent metatheoretical frameworks, may create intractable problems for explanations of flow. Finally, the suitability of the ecological metatheory and eco-physical variables for explaining flow experiences is discussed.

Teacher recruitment policies: accelerating issues of spatial justice in England

ABSTRACT As well as high levels of teacher attrition, most countries around the world report some form of teacher recruitment crisis, exemplified by failed recruitment targets and high levels of demand for new teachers. These issues have reached crisis point in England. The impact of the controversial ITT Market Review, and subsequent accreditation process has left parts of the country as “cold spots” with no established providers and the formation of new national “super-providers” with no track record or experience of initial teacher education. This policy initiative is an urgent issue of spatial injustice, exacerbating teacher recruitment and supply issues in areas already suffering from educational isolation. Through the application of spatial theory, we conclude that these developments have specific spatial effects: not only on the locus of teacher education (narrowly conceived around individual classrooms and practices), and on the shifting of provision to urban centres but also on the centralisation of power and control. Such spatial effects have the capacity to exacerbate the supply and retention of teachers in hard-to-staff places.

War veterans, minorities and crisis points in Yugoslav welfare

ABSTRACT This article provides an analytical overview of welfare policymaking and provision in the twentieth century in Yugoslavia at three decisive historical junctures. Those are: the Kingdom of Yugoslavia after the First World War; the socialist state after 1945; and the rump ‘Yugoslavia’ after the break-up of the state in 1991. In each of these periods welfare policies were crisis-driven, a response to massive social and economic upheaval caused by war, but they were also a reflection, of course, of the political ideals and the values of the state in which they were formed. The authors argue that the Yugoslav welfare state in its various incarnations was in part a response to socio-economic crisis caused by war, in part a mediation and an adaptation of the welfare regime it replaced (rather than a complete tabula rasa), and in part an articulation of the aspirations for national politics and citizenship held by the incoming leadership of the state. This comparative study of three important moments in Yugoslavia’s welfare history, then, offers an opportunity to look anew at the social history of the state itself. Study of the Yugoslav welfare model, or rather models, helps us understand the larger political transformations that were bound up in the lifespan of the South Slav state, how the state thought about and created minorities through welfare regimes, and how welfare policies withstood (or not) socio-economic crisis.

Care and Crisis: Making Beds in the National Health Service

Abstract In July 1979, the Sunday Mirror published an article with the headline: “HOSPITALS AT CRISIS POINT: Jobs and beds to go in cash curbs.” In this article we explore the role of hospital beds in such public discussions of “crisis” within the British National Health Service (NHS). In the 1970s, the media and politicians paid increasing attention to bed numbers as an indicator of resource scarcity within the NHS. While this in part reflected a genuine trend, it was also a powerful narrative device. The hospital bed has become a cipher for NHS resourcing and resilience, but throughout the twentieth century, there has been a tension between stories of declining bed numbers as a sign of “crisis,” and declining bed numbers as a marker of more efficient, high-quality healthcare. This article will show that the hospital bed was an extremely important political device because it was imbued with rich social and cultural symbolism, and that stories of declining bed numbers were not as straightforward as they first appear. While discussions in the public sphere tended to focus on bed numbers and waiting times, discussions in the healthcare sector and among policymakers attended to what beds could—and should—do for both patients and staff. Public rhetoric about decline was less about the object itself, and more about the role of the hospital bed as a symbol of care and as a politically pertinent shorthand for the health of the NHS as an institution.

Scaling artificial heat islands to enhance precipitation in the United Arab Emirates

Abstract. Potential for regional climate engineering is gaining interest as a means of solving regional environmental problems like water scarcity and high temperatures. In the hyper-arid United Arab Emirates (UAE), water scarcity is reaching a crisis point due to high consumption and over-extraction and is being exacerbated by climate change. To counteract this problem, the UAE has conducted cloud-seeding operations and intensive desalination for many years but is now considering other means of increasing water resources. Very large “artificial black surfaces” (ABSs), made of black mesh, black-painted, or solar photovoltaic (PV) panels have been proposed as a means of enhancing convective precipitation via surface heating and amplification of vertical motion. Under the influence of the daily UAE sea breeze, this can lead to convection initiation under the right conditions. Currently it is not known how strong this rainfall enhancement would be or what scale of black surface would need to be employed. This study simulates the impacts at different ABS scales using the WRF-Noah-MP model chain and investigates impacts on precipitation quantities and underlying convective processes. Simulations of five square ABSs of 10, 20, 30, 40, and 50 km sizes were made on four 1 d cases, each for a period of 24 h. These were compared with a Control model run, with no land use change, to quantify impacts. The ABSs themselves were simulated by altering land cover static data and prescribing a unique set of land surface parameters like albedo and roughness length. On all 4 d, rainfall is enhanced by low-albedo surfaces of 20 km or larger, primarily through a reduction of convection inhibition and production of convergence lines and buoyant updrafts. The 10 km square ABS had very little impact. From 20 km upwards there is a strong scale dependency, with ABS size influencing the strength of convective processes and volume of rainfall. In terms of rainfall increases, 20 km produces a mean rainfall increase over the Control simulation of 571 616 m3 d−1, with the other sizes as follows: 30 km (∼ 1 million m3 d−1), 40 km (∼ 1.5 million m3 d−1), and 50 km (∼ 2.3 million m3 d−1). If we assume that such rainfall events happen only on 10 d in a year, this would equate to respective annual water supplies for > 31 000, > 50 000, > 79 000, and > 125 000 extra people yr−1 at UAE per capita consumption rates. Thus, artificial heat islands made from black panels or solar PV offer a means of enhancing rainfall in arid regions like the UAE and should be made a high priority for further research.