Background Weaknesses in the provision of mental health crisis support are evident and improvements that include voluntary sector provision are promoted. There is a lack of evidence regarding the contribution of the voluntary sector and how this might be used to the best effect in mental health crisis care. Aim To investigate the contribution of voluntary sector organisations to mental health crisis care in England. Design Multimethod sequential design with a comparative case study. Setting England, with four case studies in North England, East England, the Midlands and London. Method The method included a scoping literature review, a national survey of 1612 voluntary sector organisations, interviews with 27 national stakeholders and detailed mapping of the voluntary sector organisation provision in two regions (the north and south of England) to develop a taxonomy of voluntary sector organisations and to select four case studies. The case studies examined voluntary sector organisation crisis care provision as a system through interviews with local stakeholders (n = 73), eight focus groups with service users and carers and, at an individual level, narrative interviews with service users (n = 47) and carers (n = 12) to understand their crisis experience and service journey. There was extensive patient and public involvement in the study, including service users as co-researchers, to ensure validity. This affected the conduct of the study and the interpretation of the findings. The quality and the impact of the involvement was evaluated and commended. Main findings A mental health crisis is considered a biographical disruption. Voluntary sector organisations can make an important contribution, characterised by a socially oriented and relational approach. Five types of relevant voluntary sector organisations were identified: (1) crisis-specific, (2) general mental health, (3) population-focused, (4) life-event-focused and (5) general social and community voluntary sector organisations. These voluntary sector organisations provide a range of support and have specific expertise. The availability and access to voluntary sector organisations varies and inequalities were evident for rural communities; black, Asian and minority ethnic communities; people who use substances; and people who identified as having a personality disorder. There was little evidence of well-developed crisis systems, with an underdeveloped approach to prevention and a lack of ongoing support. Limitations The survey response was low, reflecting the nature of voluntary sector organisations and demands on their time. This was a descriptive study, so evaluating outcomes from voluntary sector organisation support was beyond the scope of the study. Conclusions The current policy discourse frames a mental health crisis as an urgent event. Viewing a mental health crisis as a biographical disruption would better enable a wide range of contributory factors to be considered and addressed. Voluntary sector organisations have a distinctive and important role to play. The breadth of this contribution needs to be acknowledged and its role as an accessible alternative to inpatient provision prioritised. Future work A whole-system approach to mental health crisis provision is needed. The NHS, local authorities and the voluntary sector should establish how to effectively collaborate to meet the local population’s needs and to ensure the sustainability of the voluntary sector. Service users and carers from all communities need to be central to this. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 29. See the NIHR Journals Library website for further project information.

The rotational angular momentum orientation and alignment of the NO fragments generated via linearly polarized 308 nm photodissociation of NO2 has been determined using laser induced fluorescence. By observing the dependence of the photofragment NO Doppler-resolved transition line shapes on experimental geometry, it has proved possible to determine multipole moments of the photofragment angular momentum distribution up to, and including, rank 3. The implications of the results for the mechanism of the dissociation are considered.

OH(OD) quantum state populations, rovibrational quantum state-resolved center-of-mass angular scattering distributions, and H2(HD) coproduct internal energy release distributions have been determined for the hot H atom reactions with H2O and D2O at mean collision energies close to 1.4 eV. The experiments employ pulsed laser photolysis coupled with polarized Doppler-resolved laser induced fluorescence detection of the radical products. The OH(2Π1/2,v′=0,N′=1,A′) and OD(2Π1/2,v′=0,N′=1,A′) angular distributions generated by the two isotopic reactions are quite distinct: that for the reaction with H2O shows intensity over a wide range of center-of-mass scattering angles, and peaks in the sideways direction, while the state-resolved angular distribution for the reaction with D2O displays more scattering in the backward hemisphere. For higher OH(OD) angular momentum states the differences in the angular distributions for the two reactions are less marked, with both systems showing a slight preference for backward scattering. The kinetic energy release distributions are insensitive to OH(OD) quantum state and to isotopic substitution, and reveal that the H2(HD) coproducts are born internally cold at 1.4 eV. OH(OD) quantum state averaged energy disposals in the two reactions are also presented. The new experiments provide detailed mechanistic information about the two reactions and clarify the dominant sources of product OH(OD) rotational excitation. Current theoretical understanding of the reaction is critically assessed.

The OH state-resolved angular momentum polarization generated by the H+N2O reaction has been investigated at a mean collision energy of 1.5 eV. The data were obtained under room temperature bulb conditions using 225 nm photolysis of H2S to generate translationally excited H atoms, and employed Doppler-resolved laser induced fluorescence to probe the nascent OH reaction products. The measurements revealed the OH rotational angular momentum, j′, to be aligned in the scattering plane (i.e., in the plane containing the reactant and product relative velocity vectors, k and k′). Furthermore, j′ was found to be preferentially aligned parallel to k′, particularly for lower OH rotational states. Out-of-plane torsional forces have been shown, therefore, to play an important role in generating OH rotation as the fragments separate. The new data are discussed in light of previously published studies of the title reaction, both from our own laboratory, and from those of other workers. Insight into the reaction mechanism is provided by comparison with the photodissociation dynamics of HN3, which helps, in particular, to clarify the origin of the propeller-like OH rotational angular momentum polarization.

IntroductionThe Independent Review of the Mental Health Act (MHA) in England and Wales confirmed increasing levels of compulsory detentions, especially for racialised communities. This research aims to: (a) understand the causes of and propose preventive opportunities to reduce the disproportionate use of the MHA, (b) use an adapted form of experience-based codesign (EBCD) to facilitate system-wide changes and (c) foreground the voices of service users at risk of detention to radically reform policy and implement new legislation to ensure the principles of equity are retained.Methods and analysisThis is a qualitative study, using a comparative case study design. This study is composed of five work packages; photovoice workshops will be conducted in eight local systems with service users and healthcare professionals separately (WP1); a series of three EBCD workshops in each local system to develop approaches that reduce detentions and improve the experience of people from racialised communities. This will inform a comparative analysis and national knowledge exchange workshop (WP2); an evaluation led by the patient and public involvement group to better understand what it is like for people to participate in photovoice, codesign and participatory research (WP3); an economic evaluation (WP4) and dissemination strategy (WP5). The impact of the involvement of patients and public will be independently evaluated.Ethics and disseminationThis study is sponsored by the University of Oxford and granted ethical approval from the NHS Research Ethics Committee and Health Research Authority (21/SC/0204). The outputs from this study will be shared through several local and national channels.