Individuals In Crisis Research Articles

Creating Comprehensive Crisis Response Systems: An Opportunity to Build on The Promise of 988.

The implementation of a national suicide prevention hotline is imminent and will need to be supported by comprehensive crisis systems, which are currently rarely implemented in part due to their cost. In this Commentary paper we identify three core components of a high-functioning, integrated crisis service system. We identified regional crisis call centers, mobile response teams, and crisis receiving and stabilization centers as core components of an integrated crisis service system. We then outline how this approach has been used in Arizona. Building out these systems and sustainable funding models to support these systems is necessary to ensure that 988 implementation lives up to the promise of creating a lifeline to support services for individuals in crisis.

988 is Coming, But Most Localities Still Not Prepared

988 is Coming, But Most Localities Still Not Prepared

Supporting Patrons in Crisis through a Social Work-Public Library Collaboration

Individuals experiencing psychosocial crises have sought support and refuge in libraries for decades, and at increasing rates. Library staff interacts with individuals in crisis using professional knowledge and attitudes, of which crisis intervention and related work is rarely a part. We hypothesized that librarian-social work collaboration could deliver crucial knowledge and skill development for library staff, positively affecting attitudes and improving public libraries’ service provision. We facilitated a series of workshops co-designed by social workers and librarians which address topics identified in prior research. Pre- and post-workshop assessments provided data about participants’ knowledge and attitude changes. Findings indicate the workshops increased knowledge and altered attitudes around each topic. These results are discussed in the context of current literature on social work-library interprofessional collaborations, with a focus on trauma-informed librarianship, and implications for the next steps will be explored.

Knowledge, Skills, and Abilities for Managing Potentially Volatile Police-Public Interactions: A Narrative Review.

We conducted a narrative review of existing literature to identify the knowledge, skills, and abilities (KSAs) necessary for officers who police in democratic societies to successfully manage potentially volatile police–public interactions. This review revealed 10 such KSAs that are frequently discussed in the literature. These KSAs include: (1) knowledge of policies and laws; (2) an understanding of mental health-related issues; (3) an ability to interact effectively with, and show respect for, individuals from diverse community groups; (4) awareness and management of stress effects; (5) communication skills; (6) decision-making and problem-solving skills; (7) perceptual skills; (8) motor skills related to use-of-force; (9) emotion and behavior regulation; and (10) an ability to treat people in a procedurally just manner. Following our review, we conducted semi-structured interviews (N = 7) with researchers who specialize in police training and adult education, interactions with individuals in crisis, and racialized policing, as well as two police trainers with expertise in de-escalation and use-of-force training. These interviews confirmed the importance of the 10 KSAs and highlighted two additional KSAs that are likely to be critical: understanding the role of policing in a free and democratic society and tactical knowledge and skills. To ensure that police–public interactions are managed effectively, police trainers may want to focus on the development and evaluation of these KSAs—something that is not always done currently.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

The crisis “Archetypogram” – of prisoners, soldiers, sages and jesters

Introduction: Archetypes in psychology are complete models of behaviours, thoughts and feelings, representative of universal experiences. From Plato’s description of Forms to Jung’s analytical introduction to archetypes in psychology, to common use of Moore’s masculine archetypes in popular culture, we use such “complete representations” to enable change. Methods: In examining psychologically driven responses to the recent and ongoing pandemic crisis, the use of a graphic representation of interacting archetypes is proposed—the ‘archetypogram’. Results: Drawing on concepts from psychodynamic therapy practise, including Transactional Analysis and Jungian theory, four main archetypes are proposed for their interdependence—the prisoner, the soldier, the sage and the jester/trickster, and a model describing their interactions is presented with the intention of enabling helpful behaviours in response to crisis. The model further proposes positive and negative positions within each archetype, labelled as ‘creating’ and ‘consuming’ behaviours respectively. The ‘archetypogram’ thus is a visual representation of three main components - the four archetypes, creating vs consuming behaviours, and movement between the various positions. Use of the ‘archetypogram’ is aimed at enabling individuals in crisis to move from consuming to creating behaviours. Conclusion: The ‘archetypogram’ is a model of change which may be applied to persons distressed in crisis, and is able to move behaviours towards positive and creating self-states.

The MATES Case Management Model: Presenting Problems and Referral Pathways for a Novel Peer-Led Approach to Addressing Suicide in the Construction Industry.

MATES in Construction (MATES) is a multimodal, peer-led, workplace suicide prevention and early intervention program developed to reduce the risk of suicide among construction industry workers through active facilitation of appropriate support. The MATES case management model provides an example of a nonclinical service for meeting the needs of individuals in the construction industry who, while at elevated risk of mental health problems and suicidality, are traditionally less likely to seek help. The aim of this research was to conduct an evaluation of the MATES case management database to quantify service demand, and to examine the demographic, occupational profile, presenting issues, referral pathways, and perceived benefit of case management among individuals who used this service. The research reports on routinely collected data from the Queensland MATES case management database, which contains records on 3759 individuals collected over the period 2010–2018, and findings from a small and opportunistic exit survey undertaken with 14 clients in 2019. Overall, findings suggest that the demand for case management through MATES has increased significantly and that clients felt that their needs and concerns were appropriately addressed. The most common presenting issues were relationship, work, and family problems, suicide, and mental health concerns. Findings confirm that causes of distress extend beyond the realm of mental disorder and span a range of psychosocial issues. Significantly, it offers an approach that may divert individuals in crisis away from presenting to over-run emergency departments, and towards services that are more equipped to meet their individual needs.

Engaging unhoused community members in the design of an alternative first responder program aimed at reducing the criminalization of homelessness.

Police are often called to address concerns about people experiencing homelessness, with arrests often resulting from low-level, nonviolent crimes, and violations of minor nuisance ordinances. In Portland, Oregon, advocates lobbied for a new model of emergency response for 911 calls involving unhoused community members and people experiencing behavioral health crises. To ensure the program reflected the needs and perspectives of people experiencing homelessness, teams of researchers, community volunteers, and people with lived experience interviewed 184 people in camps, shelters, and parks. Teams asked unhoused people how the program should be designed, including who the first responders should be, how they should approach individuals in crisis, what resources they should provide, and how they should be trained. This article describes the methods, findings, and recommendations from our collaborative survey process aimed at ensuring that the voices of people experiencing homelessness informed the development of the Portland Street Response pilot program.

CCBHC Thrive launches MAT with CODAC in Rhode Island

Last week, Thrive Behavioral Health and CODAC Behavioral Healthcare announced they would work together to provide medication‐assisted treatment (MAT) for opioid use disorder adjacent to Kent Hospital in Rhode Island. A certified community behavioral health Clinic (CCBHC), Thrive provides a comprehensive range of services that increase access, stabilize individuals in crisis and treat children, adults and families facing serious, complex mental illnesses and substance use disorders. “When Thrive applied for the CCBHC grant, we were charged with identifying gaps in services and creating solutions to those gaps that would break down treatment barriers,” stated Dawn Allen, CCBHC project director. “We determined that there was a need for medication‐assisted treatment in Kent County. Together with CODAC, we are connecting our community members to high‐quality treatment, decreasing their risk of experiencing a fatal overdose, expediting their transitions into long‐term recovery and providing support for them to live healthy, fulfilling lives.” CODAC's President and CEO Linda Hurley stated, “We are proud to partner with Thrive Behavioral Health on this important initiative. Together, we are moving forward in treating individuals struggling with addiction as patients, just like those facing diabetes or cancer, and offering them the most comprehensive, evidence‐based therapeutic approaches available.” Founded in 1971, CODAC has provided MAT services in Rhode Island for more than 40 years, and is the state's longest‐running not‐for‐profit outpatient opioid use disorder treatment provider. CODAC will administer the MAT services, and additional clinical support will come from Thrive's adult outpatient program, which offers wraparound services including individual, group and family counseling; psychiatric medication evaluation and management; case management services;, and an Intensive Outpatient Program for substance use and co‐occurring substance use and mental health disorders.

Design of a Decision Support Application to Support Individuals in Mental Health Crisis

Mental health and suicide are two substantial issues facing our society. They have far reaching impacts on the healthcare and public safety systems, the economy, and human life. Despite their impact and importance, the amount of research is disproportionate to the magnitude of the problem. The current study sought to determine decision requirements of those in mental health crisis and to translate them into a user-friendly mobile application. Individuals who had been in mental health crises and mental health professionals were interviewed. Results showed that both the availability of resources and the impact of anxiety and overwhelm on decision making are areas in which individuals in crisis can be better supported. Outcome of research included design of a prototype mobile application designed to support decision making during mental health crisis.

Empowering Caseworkers to Better Serve the Most Vulnerable with a Cloud-Based Care Management Solution.

Care-management tools are typically utilized for chronic disease management. Sonoma County government agencies employed advanced health information technologies, artificial intelligence (AI), and interagency process improvements to help transform health and health care for socially disadvantaged groups and other displaced individuals. The objective of this case report is to describe how an integrated data hub and care-management solution streamlined care coordination of government services during a time of community-wide crisis. This innovative application of care-management tools created a bridge between social and clinical determinants of health and used a three-step approach-access, collaboration, and innovation. The program Accessing Coordinated Care to Empower Self Sufficiency Sonoma was established to identify and match the most vulnerable residents with services to improve their well-being. Sonoma County created an Interdepartmental Multidisciplinary Team to deploy coordinated cross-departmental services (e.g., health and human services, housing services, probation) to support individuals experiencing housing insecurity. Implementation of a data integration hub (DIH) and care management and coordination system (CMCS) enabled integration of siloed data and services into a unified view of citizen status, identification of clinical and social determinants of health from structured and unstructured sources, and algorithms to match clients across systems. The integrated toolset helped 77 at-risk individuals in crisis through coordinated care plans and access to services in a time of need. Two case examples illustrate the specific care and services provided individuals with complex needs after the 2017 Sonoma County wildfires. Unique application of a care-management solution transformed health and health care for individuals fleeing from their homes and socially disadvantaged groups displaced by the Sonoma County wildfires. Future directions include expanding the DIH and CMCS to neighboring counties to coordinate care regionally. Such solutions might enable innovative care-management solutions across a variety of public, private, and nonprofit services.

The Time of Dialectic Spiritualism: From Medina to Mecca Charter

A crisis is a call for change and creative thinking that initiates a dialectics of thought and action. Also, the challenge for nations as well as individuals in crisis is to figure out which parts of their identities are already functioning well and do not need changing, and which parts are no longer working and do need changing. Indeed, Muslim thought today needs the courage to recognize what must be changed in order to deal with the new circumstances.
 But, at the same time, Muslim scholars need to draw a line and stress the elements that are so fundamental to the faith and culture of Islam that they refuse to be changed. This state of affairs we call dialectical spiritualism, as opposed to Marxist „dialectical materialism“. It is time for humanity to meet the Zeitgeist, „Spirit of the Age“, which is „the Spirit of Peace“ among religions and nations across the globe. History, past and present, is not void of good examples of accords, charters, declarations and commitments to peaceful coexistence between religions and nations from the Medina Charter (622), the Magna Carta Libertatum (1215), the Universal Declaration of Human Rights (1948), the Nostra Aetate (1965), the Declaration of European Muslims (2005), the Common Word Between Us and You (2007), the Marrakesh Declaration (2016), the Alliance of Virtue for the Common Good (2018), the Declaration of Human Fraternity (2019) to the Mecca Charter (2019).
 All these initiatives, past and present, promote the idea of „the Spirit of Peace“ of all times, but this current time has the biggest need of all times for the Zeitgeist, „Spirit of the Age“, which is the „Spirit of Peace and Tolerance“. This paper attempts to explain this need from a Muslim perspective with a comparison with other initiatives.

Online help for people with suicidal thoughts provided by charities and healthcare organisations: a qualitative study of users\u2019 perceptions

PurposeInternet use is common among people with suicidal feelings and a considerable amount of suicide help material is available online. Despite attempts to promote formal help sites (e.g. governmental and charity sector) in internet search results, users’ evaluation of these sites is lacking. This study, therefore, aimed to explore distressed users’ perceptions of formal online help and their experiences of using this in times of crisis.MethodsIn-depth interview study of 53 adults reporting suicide-related internet use.ResultsWhile highly valued in relation to general mental health problems, formal sites were not perceived to meet the different needs of those experiencing suicidal thoughts, and did not engage individuals in crisis. Sites were criticised for being impersonal, dispassionate, too focused on information-giving, and lacking solutions that were novel or sensitive to reasons why an individual may choose to seek help online. Most participants criticised the tendency for sites to signpost to offline services as their primary response. Participants desired immediacy and responsive online help incorporating ‘live chat’, self-help tools, opportunities to interact with others and lived-experience content. Positive accounts of seeking online help described sites incorporating these features.ConclusionsFormal online help services should be reappraised to ensure they meet users’ needs for immediacy and responsive help to capitalise upon the opportunity available for suicide prevention.

Clinical characteristics and care pathways of patients with personality disorder who died by suicide.

It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.

The significance ascribed to contacting a diaconal suicide-prevention crisis line in Norway: a qualitative study

ABSTRACT Suicide-prevention crisis lines worldwide offer support to individuals in crisis, nonetheless, there is limited in-depth knowledge as to the significance of contacting these services from the service-users’ first-hand perspectives. This study aimed to provide a deeper understanding of the significance ascribed to contacting a diaconal suicide-prevention crisis line in Norway. In-depth qualitative interviews were conducted with nine callers. The material was analysed using systematic text condensation. The analysis revealed three main themes reflecting the crisis line’s emotional, relational and existential support functions in terms of providing: (i) immediate emotional availability, (ii) experiences of connectedness and acceptance, and (iii) a safe space for existential meaning-making processes. The findings point to the need for future research on the value of integrating biopsychosocio-existential perspectives into intervention models within the field of crisis support.

San Francisco leads the way to offer nation's first universal MH care system

Observing a need to prioritize serving individuals in crisis, particularly those individuals who are homeless, the San Francisco Board of Supervisors last month unanimously approved overhauling the city's mental health system and guaranteeing mental health care to all San Franciscans who lack insurance, and close care gaps. The program is considered the most comprehensive in the country to address access and service needs for people with mental illness, say officials.

FCC, Congress Close to Designating 988 as Suicide Hotline Number

FCC, Congress Close to Designating 988 as Suicide Hotline Number

Investigating mental health crisis in youth with autism spectrum disorder.

Evidence suggests that youth with autism spectrum disorder (ASD) are at increased risk for experiencing a mental health crisis. Yet, limited systematic research exists on this topic. This study examines the prevalence, phenomenology, and correlates of mental health crisis in children, adolescents, and young adults with ASD. Participants included 462 parents of individuals with ASD (83% male, 86% Caucasian, M = 13.7 years, SD = 4.7) who were enrolled in the Interactive Autism Network, a large online registry of families of individuals with ASD. Parents completed the Mental Health Crisis Assessment Scale, a psychometrically sound measure of mental health crisis for youth with ASD, as well as measures of parental depression, family quality of life, and mental health treatment history. Overall, 32% of parents reported that their child had experienced a mental health crisis during the last 3 months. In the younger group, elopement (88%) and self-injury (81%) were the most frequent behaviors contributing to crisis; physical (60%) and verbal (42%) aggression were the most frequent crisis behaviors in the older group. Correlates of crisis included younger age, increased parental depressive symptoms, and lower family quality of life. Approximately 75% of individuals in crisis had seen a psychiatrist or behavioral therapist/psychologist within the last 3 months and 25% were not engaged in any mental health treatment. In summary, mental health crises were quite prevalent in this online sample of youth with ASD. Identification and treatment of these serious events is critical to reduce morbidity in this population. Autism Res 2020, 13: 112-121. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study examines the prevalence and characteristics of mental health crisis in children, adolescents, and young adults with autism spectrum disorder. We found that 32% of individuals in our study had experienced a mental health crisis within the last 3 months. Younger age, increased parental depression, and lower quality of life were associated with crisis. These findings emphasize the importance of developing child and family-based interventions to prevent and treat the mental health crisis in this population.

Resource Document on Risk-Based Gun Removal Laws.

(Reprinted with permission from APA Resource Document, June 2018).

The utility of artificial intelligence in suicide risk prediction and the management of suicidal behaviors.

Suicide is a growing public health concern with a global prevalence of approximately 800,000 deaths per year. The current process of evaluating suicide risk is highly subjective, which can limit the efficacy and accuracy of prediction efforts. Consequently, suicide detection strategies are shifting toward artificial intelligence platforms that can identify patterns within 'big data' to generate risk algorithms that can determine the effects of risk (and protective) factors on suicide outcomes, predict suicide outbreaks and identify at-risk individuals or populations. In this review, we summarize the role of artificial intelligence in optimizing suicide risk prediction and behavior management. This paper provides a general review of the literature. A literature search was conducted in OVID Medline, EMBASE and PsycINFO databases with coverage from January 1990 to June 2019. Results were restricted to peer-reviewed, English-language articles. Conference and dissertation proceedings, case reports, protocol papers and opinion pieces were excluded. Reference lists were also examined for additional articles of relevance. At the individual level, prediction analytics help to identify individuals in crisis to intervene with emotional support, crisis and psychoeducational resources, and alerts for emergency assistance. At the population level, algorithms can identify at-risk groups or suicide hotspots, which help inform resource mobilization, policy reform and advocacy efforts. Artificial intelligence has also been used to support the clinical management of suicide across diagnostics and evaluation, medication management and behavioral therapy delivery. There could be several advantages of incorporating artificial intelligence into suicide care, which includes a time- and resource-effective alternative to clinician-based strategies, adaptability to various settings and demographics, and suitability for use in remote locations with limited access to mental healthcare supports. Based on the observed benefits to date, artificial intelligence has a demonstrated utility within suicide prediction and clinical management efforts and will continue to advance mental healthcare forward.