Baker, J. orcid.org/0000-0001-9985-9875, Clibbens, N., Booth, A. et al. (6 more authors) (2023) Explaining context, mechanism, and outcome in adult community mental health crisis care: a realist evidence synthesis. International Journal of Mental Health Nursing, 32 (6). pp. 1636-1653. ISSN 1445-8330
Abstract
Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | crisis intervention; crisis resolution; interagency services; mental health; realist methods; shared decision-making |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Healthcare (Leeds) > Nursing Mental Health (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research NIHR127709 |
Depositing User: | Symplectic Publications |
Date Deposited: | 22 Sep 2023 15:13 |
Last Modified: | 19 Nov 2024 10:29 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/inm.13204 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:202086 |