Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review

Abstract

ObjectiveTo review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders.DesignA systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants’ experiences were included.Data sourcesMEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed.Data extraction and synthesisTwo reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed.ResultsWe identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where ‘frequent attenders’ are repeatedly let down by mental health services.ConclusionLack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.

Digital Strategies to Accelerate Help-Seeking in Youth With Psychiatric Concerns in New York State

“…The Internet may serve as a critical resource to connect with concerned youth and their allies at the earliest possible time in the help-seeking trajectory, when individuals first begin to search for information online. While many individuals describe their first contact with psychiatry as a negative and often traumatic experience ( 42 ), online resources, staffed by peers and mental health professionals, such as the NYWell project offers an opportunity to ease the introduction to care, paving the way for greater engagement with services and thus improved outcomes for youth with behavioral health conditions.…”

Lifetime Incidence of Treated Mental Health Disorders and Psychotropic Drug Prescriptions and Associated Socioeconomic Functioning

“…The overall finding that the vast majority of people during their lifetime get treatment for mental health disorder/ prescription of psychotropics in primary or secondary health care settings that is associated with long-lasting decreased socioeconomic functioning turns around the definition of normalcy in relation to mental health disorder. This finding can be leveraged in anti-stigma programming 18,19 and used to alter the conception of what it means to have mental illness. Notably, although the finding of this high lifetime cumulative incidence of mental health disorder/prescription of psychotropics is new, it is not a new phenomenon; in fact, the incidence of any mental health disorder/prescription of psychotropics decreased with calendar time.…”

Police in England and Wales step back from mental healthcare

“…Police involvement in these circumstances is lifesaving in some cases but can make the individual concerned feel like a criminal 2. In the HM Inspectorate of Constabulary and Fire Services’ 2018 report, Picking up the Pieces, 3 the police are commended for responding to people in crisis with understanding and empathy.…”