Crisis Services Research Articles

Barriers to and Facilitators of Effective Behavioral Health Crisis Care Services.

Expanded funding to support care across the crisis continuum is intended to improve behavioral health outcomes. A greater understanding of how to effectively implement and integrate local crisis care systems has been identified as a research and policy priority. The aim of this study was to explore provider perceptions of the barriers and facilitators associated with implementing effective behavioral health crisis services. The authors conducted semistructured qualitative interviews with personnel from 15 behavioral health crisis care programs across California. Purposive sampling was used to ensure adequate representation of peer specialists, clinicians, mental health workers, and program leaders. Interview transcripts were analyzed via an inductive approach to thematic analysis. On the basis of patterns identified in the data, initial codes were developed, reviewed, and combined into overarching preliminary themes and subthemes. Twenty-nine crisis care personnel participated. Facilitators of effective crisis care included an optimal crisis service structure, a client-centered approach, engagement with clients' support systems, and collaboration with community partners to link clients to services and enable safe delivery of crisis care. Barriers at the client, program, and system levels were identified, with solutions proposed for each. The participants identified features of crisis care that could improve program implementation and effectiveness or could help mitigate identified barriers. As states and local municipalities work to implement an integrated system of care across the crisis care continuum, input from frontline providers can be used to support the development of new programs, refine existing services, and inform future directions for research.

Collaboration and consent in decisions to initiate emergency dispatches for suicide risk: A national qualitative study.

This study sought to better understand discussions of emergency dispatches (i.e., activation of local crisis services to conduct a welfare check) and the circumstances under which Veterans Crisis Line (VCL) callers and responders feel they are able contribute to (collaboration) and agree upon (consent) the decision to initiate an emergency dispatch. Semi-structured interviews gathered data on veterans' (n = 40) experiences receiving an emergency dispatch and VCL responders' (n = 35) perspectives on initiating dispatches. Data were analyzed using a thematic analysis approach. Veterans calling the VCL were often seeking emotional support and were surprised to receive a suicide risk assessment and emergency dispatch. Responders reported they strive for collaboration and consent prior to sending a dispatch, but the crisis setting challenged this ideal. Overall, veterans and responders described similar features of the ideal, collaborative conversation about dispatches yet noted threats to achieving collaboration: complex standard operating procedures, responder training quality, and responder lack of comfort with de-escalation. Increasing veteran awareness of VCL services, altering the timing and type of suicide risk assessment, enhancing de-escalation skill, increasing consistency of VCL responder proficiencies, and revising guidelines for dispatch disclosure were identified as ways to improve collaboration and consent around emergency dispatches.

Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study.

Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one's own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work.

Demographic variation in preferred sources for suicide prevention and mental health crisis services among U.S. adults

IntroductionRecent federal policy initiatives (e.g., 988 Lifeline, Certified Community Behavioral Health Clinics) aim to increase access to mental health crisis services. The objective of this study was to determine the prevalence and correlates of U.S. adults reporting being “very likely” to reach out to different sources if they/a loved one were experiencing suicidality or a mental health crisis. MethodsA nationally representative Ipsos KnowledgePanel survey of 5,058 U.S. adults (response rate = 55.0 %) in English and Spanish was conducted in June 2023. Multivariable logistic regression models assessed the reported likelihood of reaching out to five different sources of support in a crisis, controlling for past 30-day psychological distress and demographic characteristics. ResultsOne-in-four respondents (27.8 %; 95 % CI = 26.5 %, 29.0 %) were very likely to reach out to a crisis line and 33.6 % (95 % CI = 32.3 %, 34.9 %) were very likely to reach out to a mental health professional. A friend/family member was the most frequently identified source of support (44.7 %; 95 % CI = 43.4 %, 46.1 %). After adjustment, people of younger ages, male gender, and identifying as Republican had significantly lower odds of reporting being very likely to reach out to a crisis line and mental health professional. Black and Hispanic respondents had significantly higher odds of reporting being very likely to reach out to a crisis line and someone in their religious network than non-Hispanic Whites. ConclusionsMost U.S. adults report not being very likely to reach out to a crisis line or mental health professional if experiencing suicidality/crisis, although variation across demographic groups exists.

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.

Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation.

People with severe mental illness who experience co-occurring substance use experience poor outcome including suicide, violence, relapses and use of crisis services. They struggle to access care and treatment due to a lack of an integrated and co-ordinated approach which means that some people can fall between services. Despite these concerns, there is limited evidence as to what works for this population. To undertake a realist evaluation of service models in order to identify and refine programme theories of what works under what contexts for this population. Realist synthesis and evaluation using published literature and case study data. Mental health, substance use and related services that had some form of service provision in six locations in the United Kingdom (five in England and one in Northern Ireland). People with lived experience of severe mental illness and co-occurring substance use, carers and staff who work in the specialist roles as well as staff in mental health and substance use services. Eleven initial programme theories were generated by the evidence synthesis and in conjunction with stakeholders. These theories were refined through focus groups and interviews with 58 staff, 25 service users and 12 carers across the 6 case study areas. We identified three forms of service provision (network, consultancy and lead and link worker); however, all offered broadly similar interventions. Evidence was identified to support most of the 11 programme theories. Theories clustered around effective leadership, workforce development and collaborative integrated care pathways. Outcomes that are meaningful for service users and staff were identified, including the importance of engagement. The requirement for online data collection (due to the COVID-19 pandemic) worked well for staff data but worked less well for service users and carers. Consequently, this may have reduced the involvement of those without access to information technology equipment. The realist evaluation co-occurring study provides details on how and in what circumstances integrated care can work better for people with co-occurring severe mental health and alcohol/drug conditions. This requires joined-up policy at government level and local integration of services. We have also identified the value of expert clinicians who can support the workforce in sustaining this programme of work. People with co-occurring severe mental health and alcohol/drug conditions have complex and multifaceted needs which require a comprehensive and long-term integrated approach. The shift to integrated health and social care is promising but will require local support (local expert leaders, network opportunities and clarity of roles). Further work should evaluate the effectiveness and cost-effectiveness of service models for this group. This study is registered as PROSPERO CRD42020168667. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128128) and is published in full in Health Technology Assessment; Vol. 28, No. 67. See the NIHR Funding and Awards website for further award information.

Suicidal Thoughts and Behaviors in People on the Autism Spectrum.

This review synthesizes recent research on suicidal thoughts and behaviors among autistic individuals. We present literature on risk and protective factors, risk assessment, intervention, and crisis services, and recommendations for future research. Literature on this topic has grown substantially in recent years. Areas of advancement include improved understanding of risk factors (e.g., Interpersonal Theory of Suicide constructs, autistic burnout, mental health conditions, cognitive factors, diagnosis timing, emotion dysregulation), screening, assessment, acute-care services, and suicide-specific psychosocial treatments (e.g., safety planning, dialectical behavior therapy). Gaps include protective factors, impact of intersectional identities, and tailored approaches to screening, assessment, and intervention. Heightened awareness of suicide risk in autistic individuals has led to increased understanding of why autistic individuals think about and attempt suicide and the strategies used to identify and reduce suicide risk. We recommend community-partnered, multi-faceted, and strength-based approaches to inform tailored prevention and intervention efforts.

Evaluating the Impact of AICS on Chronic Illness Management: A Case Study of Assistance to Individuals in Crisis Situation (AICS) Service in Cagayan de Oro City, Philippines

As the leader in social protection, the Medical Aid for Patients program, a type of assistance under the Assistance to Individuals in Crisis Situation (AICS), consistently implements AICS services to support government efforts in providing aid to individuals and families in need. This is a stop-gap measure to support the recovery of individuals and families suffering from unexpected life events adversities or crises. This study explores the efficiency of medical assistance received by clients with chronic illness in Cagayan de Oro City using a qualitative case study design. A purposeful method was used to comprise the 15 participants who are active AICS beneficiaries and residents in Cagayan de Oro City. The data were collected using In-depth Interview (IDI), Focus Group Discussion (FGD), and Key Informant Interview (KII). The Hyper-RESEARCH software was utilized to help the researcher identify codes, categories, and themes. Based on the narratives of the participants, four themes emerged: Necessity, Obtainability of Services, Responsive Services, and Saving Lives. The AICS is not only a big help, but patients with chronic illness describe the service as an extension of their lives. It is, thus, recommended to strengthen the Local Government Units, LGU's partnership and other stakeholders to sustain the efficiency of the implementation of the AICS services. Future research may consider the evaluation of the assistance to individuals in crisis services particularly the impact of Institutionalization Standard Operation or ISO accreditation on the efficiency of service in the Crisis Intervention Section in Cagayan de Oro City. This study takes a qualitative approach as the intent is to comprehend the intricate issues influencing the quality of medical assistance for beneficiaries during crises

A National Snapshot of Training and Technical Assistance Needs Within the Mental Health Workforce.

This report summarizes results from a national survey that aimed to assess the training and technical assistance needs of individuals who work in mental health. A survey was distributed to mental health workers by 10 regional centers of a large, nationwide, federally funded training and technical assistance network during January-October 2021. A total of 2,321 individuals from 58 states and territories responded to the survey. The three training and technical assistance needs they indicated most frequently were equitable and culturally responsive services, co-occurring mental and substance use disorders, and mental health awareness and literacy. The survey findings reflect the continued need to address inequities in mental health services, particularly for communities of color. In addition, a cluster of topics (i.e., mental health awareness and literacy, trauma-informed care, crisis services, grief, and provider well-being) stemmed from the COVID-19 pandemic and its effects on the nation's mental health.

Characterizing Crisis Services Offered by Certified Community Behavioral Health Clinics: Results From a National Survey.

The authors aimed to examine how certified community behavioral health clinics (CCBHCs) fulfill crisis service requirements and whether clinics added crisis services after becoming a CCBHC. National survey data on CCBHC crisis services were paired with data on clinic features and the demographic and socioeconomic characteristics of the counties within a CCBHC service area. The dependent variables were whether CCBHCs provided the three categories of CCBHC crisis services (i.e., crisis call lines, mobile crisis response, and crisis stabilization) directly or through another organization and whether these services were added after becoming a CCBHC. Descriptive statistics and multivariable logistic regression analyses were performed with data about clinics and the counties they served. In total, 449 CCBHCs were surveyed in the summer of 2022, with a response rate of 56%. The final sample comprised 247 clinics. The number of CCBHC employees per 1,000 people within a CCBHC service area was significantly and positively associated with clinics providing some crisis services directly (mobile crisis response: adjusted OR [AOR]=1.46, 95% CI=1.08-1.98; crisis stabilization services: AOR=1.60, 95% CI=1.17-2.19). Compared with clinics that did not receive a CCBHC Medicaid bundled payment, clinics that received this payment had higher odds of adding mobile crisis response (AOR=2.52, 95% CI=1.28-4.97) and crisis stabilization services (AOR=3.19, 95% CI=1.51-6.72) after becoming a CCBHC. CCBHC initiatives, particularly CCBHC Medicaid bundled payments, may provide opportunities to increase the availability of behavioral health crisis services, but the sufficiency of this increase for meeting crisis care needs remains unknown.

The UT Health Living Room: Expanding the Psychiatric Crisis Continuum of Care.

Traditional forms of psychiatric crisis treatment increasingly are being buttressed by services along the Psychiatric Crisis Continuum of Care, such as short-term crisis stabilization services and peer crisis services. The UT Health Living Room (LR) is an outpatient crisis counseling service that adds three promising elements to the Continuum: (1) it integrates outpatient treatment plans into crisis counseling, (2) provides care in a space and with staff who are familiar to patients, and (3) provides training in evidence-based crisis intervention. We examined two-year LR feasibility and outcome data. Mixed-method analyses used longitudinal clinic data and patient self-report measures. Results provide initial support for the feasibility, cost effectiveness and clinical effectiveness of the LR. Limitations include non-blinded ratings, limited experimental control, and simple cost-effectiveness methodology. The UT Living Room is feasible and offers novel elements to help patients in community clinics address emotional crises.

Crisis Intercept Mapping for Community-Based Suicide Prevention: An Assessment of the Crisis Infrastructure and Future Considerations for 988.

Suicide is a significant public health problem, yet barriers to treatment remain. To address barriers and meet needs, Congress designated a new 988 dialing code to increase utilization of the National Suicide Prevention Lifeline. As a result, call volume increased, and demand for community-based crisis services is expected. To examine the availability of community-based crisis care, we analyzed information collected from 2020 to 2022 Crisis Intercept Mapping (CIM) technical assistance workshops conducted with communities across the country. We found that training and implementation of suicide risk screening, safety planning, lethal means safety, and follow-up were limited and inconsistent among communities in our study. Collaboration was variable, impacting the ability of communities to support care transitions. Participants described multiple barriers to the routine implementation of evidence-based care and identified potential solutions for addressing them. Findings suggest a need for relationship building and targeted education and training to meet future demand for crisis care.

Study protocol for an adaptive, multi-arm, multi-stage (MAMS) randomised controlled trial of brief remotely delivered psychosocial interventions for people with serious mental health problems who have experienced a recent suicidal crisis: Remote Approaches to Psychosocial Intervention Delivery (RAPID)

BackgroundPeople with serious mental health problems (SMHP) are more likely to be admitted to psychiatric hospital following contact with crisis services. Admissions can have significant personal costs, be traumatic and are the most expensive form of mental health care. There is an urgent need for treatments to reduce suicidal thoughts and behaviours and reduce avoidable psychiatric admissions.MethodsA multi-stage, multi-arm (MAMS) randomised controlled trial (RCT) with four arms conducted over two stages to determine the clinical and cost effectiveness of three psychosocial treatments, compared to treatment as usual (TAU), for people with SMHP who have had recent suicidal crisis. Primary outcome is any psychiatric hospital admissions over a 6-month period. We will assess the impact on suicidal thoughts and behaviour, hope, recovery, anxiety and depression. The remote treatments delivered over 3 months are structured peer support (PREVAIL); a safety planning approach (SAFETEL) delivered by assistant psychologists; and a CBT-based suicide prevention app accessed via a smartphone (BrighterSide). Recruitment is at five UK sites. Stage 1 includes an internal pilot with a priori progression criteria. In stage 1, the randomisation ratio was 1:1:1:2 in favour of TAU. This has been amended to 2:2:3 in favour of TAU following an unplanned change to remove the BrighterSide arm following the release of efficacy data from an independent RCT. Randomisation is via an independent remote web-based randomisation system using randomly permuted blocks, stratified by site. An interim analysis will be performed using data from the first 385 participants from PREVAIL, SAFETEL and TAU with outcome data at 6 months. If one arm is dropped for lack of benefit in stage 2, the allocation ratio of future participants will be 1:1. The expected total sample size is 1064 participants (1118 inclusive of BrighterSide participants).DiscussionThere is a need for evidence-based interventions to reduce psychiatric admissions, via reduction of suicidality. Our focus on remote delivery of established brief psychosocial interventions, utilisation of different modalities of delivery that can provide sustainable and scalable solutions, which are also suitable for a pandemic or national crisis context, will significantly advance treatment options.Trial registrationISRCTN33079589. Registered on June 20, 2022.

The impact of their role on telephone crisis support workers’ psychological wellbeing and functioning: Qualitative findings from a mixed methods investigation

Little is known about how telephone crisis support workers are impacted by frequent empathic engagement with callers in crisis, including those who are suicidal. This is the only known qualitative study to specifically examine the impact of their role on telephone crisis support workers’ psychological wellbeing and functioning. Eighteen telephone crisis support workers participated in semi-structured interviews, providing detailed accounts of the impact of the role on their wellbeing and functioning. Interpretive Phenomenological Analysis of interview data resulted in four key themes. Results suggest that telephone crisis support workers’ motivations, background, personal help-seeking and coping practices are likely to impact their experiences of psychological wellbeing and functioning in relation to empathic engagement with callers in crisis. Telephone crisis services should seek to integrate an understanding of workers’ experiences into the provision of training, supervision and support strategies to optimize workers’ wellbeing and functioning.

Mental and Behavioral Health, and Crisis Services for People with Intellectual and Developmental Disabilities in Medicaid Home- and Community-Based Services.

People with intellectual and developmental disabilities (IDD) often have higher rates of comorbid mental health conditions compared to the general population. Yet, many people with IDD also have unmet needs for mental and behavioral health services. The aim of this study was to examine how states provided mental and behavior health, and crisis services to people with IDD in their Home- and Community-Based Services (HCBS) programs, the largest funding mechanism for Long-Term Services and Supports (LTSS) for people with IDD in the United States. We analyzed fiscal year (2021) Medicaid HCBS waivers for people with IDD from across the United States to examine if and how they provided mental and behavior health, and crisis services. States projected spending $968.9million for mental and behavior health, and crisis services for 190,299 people with IDD. Applied behavior analysis services were provided at greater rates than positive behavior supports and other forms of behavior interventions. While most states provided mental and behavior health, and crisis services in their waivers, there were vast inconsistencies in how they did so, across states, waivers, and services. HCBS are a crucial safety net to ensure people with IDD, especially those who also have mental health disabilities, can live and thrive in their communities.

Help-Seeking Behaviors in a Community Experiencing Multiple, Concurrent Natural Disasters. Lessons from a Greater Houston Community

Previous disaster research exploring mental health consequences has been conducted after a single disaster. Community mental health nurses offer critical support in the aftermath of a disaster through complex assessments, psychosocial education and treatment. This research examines help-seeking behaviors in a Greater Houston community struggling with two simultaneous disasters, a historic winter freeze amidst the COVID-19 pandemic. Three Mental Health Crisis clinics, staffed by an interdisciplinary team, offered walk-in crisis services. The study characterizes adults who accessed services and describes those who accepted follow-up, subsidized behavioral health therapy or case management, including populations experiencing health disparities. Statistical analysis included descriptive and inferential statistics. Those who recognized the need for behavioral health care and accessed episodic care differed from those who accepted follow-up care. The population that was more likely to accept follow up care largely consisted of females, individuals without a previously existing mental health condition, those who reported trauma exposure, and young adults of Hispanic/Latino origin. Nurses can leverage female support to inspire male adults to seek care and advocate for increased resources and training to support culturally relevant care. Nurses and the interdisciplinary team need to assess for trauma exposure, as it influences care decisions.

Evaluating the Experience of Teen-to-Teen Crisis Line Volunteers: A Pilot Study.

Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14-20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth.

An Investigation Into the Acceptability of the SAFER-YMH Care Bundle for Transitions Out of CAMHS Crisis and Liaison Services

An Investigation Into the Acceptability of the SAFER-YMH Care Bundle for Transitions Out of CAMHS Crisis and Liaison Services

Introducing the Dementia Crisis Service in East Kent: Can We Reduce Rates of Hospital Admission?

Introducing the Dementia Crisis Service in East Kent: Can We Reduce Rates of Hospital Admission?

Predicting recurrent chat contact in a psychological intervention for the youth using natural language processing.

Chat-based counseling hotlines emerged as a promising low-threshold intervention for youth mental health. However, despite the resulting availability of large text corpora, little work has investigated Natural Language Processing (NLP) applications within this setting. Therefore, this preregistered approach (OSF: XA4PN) utilizes a sample of approximately 19,000 children and young adults that received a chat consultation from a 24/7 crisis service in Germany. Around 800,000 messages were used to predict whether chatters would contact the service again, as this would allow the provision of or redirection to additional treatment. We trained an XGBoost Classifier on the words of the anonymized conversations, using repeated cross-validation and bayesian optimization for hyperparameter search. The best model was able to achieve an AUROC score of 0.68 (p < 0.01) on the previously unseen 3942 newest consultations. A shapely-based explainability approach revealed that words indicating younger age or female gender and terms related to self-harm and suicidal thoughts were associated with a higher chance of recontacting. We conclude that NLP-based predictions of recurrent contact are a promising path toward personalized care at chat hotlines.