A Profile of Mental Health Crisis Response in a Rural Setting

Abstract

Systems of crisis intervention are frequently difficult to operationalize; they are often described as crisis components rather than systems, fail to differentiate levels of crisis acuity, provide very limited fundamental utilization data, and are almost exclusively implemented in urban areas. A system of rural crisis intervention differentiating levels of acuity and fundamental utilization information was profiled. Implications for clinicians and administrators are presented. This system of crisis intervention was highly effective in reducing inpatient utilization with the help of crisis residential beds and partial hospitalization. Mobile response was infrequently used in this setting. Age and gender were important variables in mental health emergency situations. Use of acute crisis level services was rarely more than once. More systematic descriptions of crisis systems of care were encouraged.

System- and Policy-Level Challenges to Full Implementation of the Crisis Intervention Team (CIT) Model

“…The transportation of individuals with a mental illness to such distant facilities can result in law enforcement officers being out of service for up to eight hours (Kempf, 2008; Sullivan & Spritzer, 1997), potentially leaving rural jurisdictions with insufficient law enforcement protection during this time (Kempf, 2008). Long distances in rural areas are also a barrier to timely psychiatric mobile unit responses, which may contribute to longer waiting times for responding officers (Bonynge, Lee, & Thurber, 2005). The development of a regional mental health treatment transport component has been suggested as a means to address the issues related to the transportation of people with mental illnesses in rural areas (Kempf, 2008).…”

Development of Clinical Ratings for Crisis Assessment In Community Mental Health

“…The setting of this research was a CMHC. A detailed description of the CMHC and crisis response service is contained elsewhere (Bonynge, Lee, & Thurber, 2005). Briefly, the CMHC is a comprehensive provider in a rural setting.…”

“…These five variables were based upon a consensus by our clinicians directly working in the crisis unit and were identified as salient characteristics of persons worthy of consideration in assessing individuals in crisis. These variables formed an operational definition of crisis requiring the presence of three or more variables (Bonynge, Lee, & Thurber, 2005). These variables were as follows: (1) danger to self, (2) danger to others, (3) functional decline, (4) confusion, and (5) depression.…”

Cairns Mental Health Co‐Responder Project: Essential elements and challenges to programme implementation

“…These instances have been defined as those where there are safety concerns for the person with mental illness (PMI) and/or members of the public. These safety concerns may be associated with significant confusion, depression, or functional decline for the PMI (Bonynge et al ; Schwarzfeld et al ). Interactions between police and PMI in these crises are recognized as having risks to both parties including the overuse of involuntary assessment orders (Meehan & Stedman, ), trauma for individuals in crisis, and their families, and more rarely, in use of lethal force by police if they are hampered by limited response options (Wood & Watson, ).…”