Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis

Banfield, Michelle; Fitzpatrick, Scott J.; Lamb, Heather; Giugni, Melanie; Calear, Alison L.; Stewart, Erin; Pavloudis, Maree; Ellen, Lucy; Sargent, Ginny; Skeat, Helen; Edwards, Bronwen; Miller, Benn; Gulliver, Amelia; Ellis, Louise A.; Bliokas, Vida; Goj, Purity; Lee, Melissa; Stewart, Kelly; Webb, Glenda C.; Main, Merkitta; Lumby, Carrie; Wells, Kelly; McKay, Carolyn; Batterham, Philip J.; Morse, Alyssa R.; Shand, Fiona

doi:10.1371/journal.pone.0272483

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…Co‐ideation, according to Pearce et al, 11 involves the use of collaborative dialogue to generate and share new and creative ideas in relation to meeting community needs, solving problems and improving service design and delivery. The shift toward the implementation of co‐created, peer‐led, nonclinical services marks a proactive response to the unmet needs of those experiencing emotional distress and/or suicidal crisis, who frequently report negative experiences of emergency department care 18 . At the same time, concerns about the short‐termism of health services mean there is considerable pressure to determine the effectiveness of these services; particularly as genuine, viable and sustainable alternatives for people who might usually present to the emergency department or choose not to access help through an emergency department due to past negative experiences.…”

Section: Resultsmentioning

confidence: 99%

“…The shift toward the implementation of co-created, peer-led, nonclinical services marks a proactive response to the unmet needs of those experiencing emotional distress and/or suicidal crisis, who frequently report negative experiences of emergency department care. 18 At the same time, concerns about the short-termism of health services mean there is considerable pressure to determine the effectiveness of these services; particularly as genuine, viable and sustainable alternatives for people who might usually present to the emergency Research funding cycles are not co-creation friendly. 9 There is typically insufficient time to build trusting relationships where power is truly shared to a necessary degree for effective co-creation.…”

Section: Co-ideation and Early Challengesmentioning

confidence: 99%

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Co‐ideation and co‐design in co‐creation research: Reflections from the ‘Co‐Creating Safe Spaces’ project

Fitzpatrick

Lamb

Stewart

et al. 2023

Health Expectations

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Introduction: Numerous frameworks for defining and supporting co-created research exist. The practicalities of designing and conducting co-created research are clearly important, yet the utility of these frameworks and their operationalisation within local contexts and involving a diversity of stakeholders and interests are currently not well-researched.Methods: Using an instrumental case study approach, we examined the utility of a published systematic framework designed to improve clarity about co-creation as a concept and approach. The framework is explored based on the first two processes that correspond to our own work to date: co-ideation and co-design.Results: Our study showed that diverse stakeholders bring challenges regarding research priorities, methods, language and the distribution of power within cocreation processes. Co-creation activities were incremental, adaptable, responsive and made best use of established relationships, structures and collective leadership to meet the competing demands of funders and human research ethics committees, while ensuring the meaningful participation of multiple stakeholders. Conclusion:The findings highlight the iterative, fluid and deeply relational nature of co-created research. Rather than seeking to categorise these processes, we argue that the social relations of research production that provide the structures within which all co-created knowledge is generated are more important drivers of effective knowledge mobilisation and implementation. Thus, close attention to these social relations is needed in co-created research.

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Section: Resultsmentioning

confidence: 99%

Section: Co-ideation and Early Challengesmentioning

confidence: 99%

Co‐ideation and co‐design in co‐creation research: Reflections from the ‘Co‐Creating Safe Spaces’ project

Fitzpatrick

Lamb

Stewart

et al. 2023

Health Expectations

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“…Rheinberger et al., 2022). There needs to be a push within the community for alternatives to EDs, as well as increased awareness of what is available and what services may be better suited to support individual needs (Banfield et al., 2022). Healthcare metrics (e.g.…”

Section: Discussionmentioning

confidence: 99%

Staff perspectives of emergency department pathways for people attending in suicidal crisis: A qualitative study

McCarthy,

McIntyre,

Nathan

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Emergency departments (ED) are key settings to support and manage suicidal crisis; thus, ED staff are often the first point of contact for people in suicidal crisis. Despite this, some ED staff receive little training and/or education on how to best support such patients. What the paper adds to existing knowledge Previous research focuses on one staffing role (e.g. triage nurses) whereas this paper includes staff working across the ED pathway. Administrative staff have often been excluded from research, despite representing a key part of the clinical pathway and being a person's initial contact with the ED. Overall findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. Staff also perceive there to be a negative ED culture, which often leads to poor attitudes towards suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention. Findings build upon previous research to highlight key challenges different staff face along the clinical pathway and the implications this can have on a patient's journey and follow‐up care provided. What are the implications for practice? Findings are of particular importance and relevance to ED managers, and more broadly NHS England. Negative ED culture, poor staff attitudes and confidence can have a detrimental impact on both staff health and wellbeing, as well as a patient's journey throughout the ED, resulting in repeat presentations and absconding as appropriate support is not received. Policymakers need to consider staff burnout and lack of resources in mental health care strategies, and training programmes should be developed to improve culture and confidence among ED staff and managers to improve care for people attending EDs in suicidal crisis. AbstractIntroductionEmergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway.AimsTo explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis.MethodQualitative study guided by thematic analysis of semi‐structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England.ResultsFindings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention.DiscussionStaff felt unequipped to deal with suicide‐related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction.Implications for PracticeFindings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED.

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“…25 Similarly, findings on the effectiveness of alternative crisis models are limited, and it is unknown what factors have contributed to the success and challenges of these approaches. 12 Still, findings indicate that alternative models to ED provide important advantages over traditional service delivery in relation to satisfaction and measures of personal recovery. 9,10,26,27 Relatively few studies have examined the lived experience of mental health crisis care more deeply and taken a hermeneutical phenomenological approach to understanding these experiences.…”

Section: Introductionmentioning

confidence: 99%

“…These approaches recognise that the ED is frequently poorly equipped to meet the needs of people in mental health crises 11 . In Australia, a recent rollout of Safe Spaces based on the Safe Haven model is yet to be evaluated 12 . Alternatives generally use nonclinical approaches that do not involve psychiatric diagnosis or treatments 10 and employ peer workers who provide support that draws on their first‐hand experience of emotional distress using relationship‐based approaches, offering hope and connection 13 .…”

Section: Introductionmentioning

confidence: 99%

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives

Roennfeldt,

Hill,

Byrne

et al. 2024

Health Expectations

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BackgroundMental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched.MethodThis study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty‐one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in‐depth interviews.ResultsThe findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after‐hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers.ConclusionThe findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning‐making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis.Patient or Consumer ContributionThe first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.

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Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis

Cited by 7 publications

References 35 publications

Co‐ideation and co‐design in co‐creation research: Reflections from the ‘Co‐Creating Safe Spaces’ project

Co‐ideation and co‐design in co‐creation research: Reflections from the ‘Co‐Creating Safe Spaces’ project

Staff perspectives of emergency department pathways for people attending in suicidal crisis: A qualitative study

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives

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