Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis.

Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom's 4 countries or regions. objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller's current region (intraregional calls) or routed to a branch that is in a different region from that of the caller's current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene's test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service.

[Psychomotricity in psychiatric institutions: when care takes shape]. / La psychomotricité en institution psychiatrique, quand le soin prend corps.

In psychiatry, psychomotricians can play an essential role in multidisciplinary teams. The specificity of their clinical vision and analysis, as well as their care tools, make them specialists in understanding the symptoms expressed by the body, and in body-mediated therapy. Able to propose interventions for patients in crisis, and to plan long-term care for stabilized chronic patients, they adapt to the temporality of the pathology. Committed to teamwork, they play their part in the multi-disciplinary weave of containing and structuring that the psychiatric institution confers on the most fragile patients.

Coordinated System of Care Approaches for Pediatric Emergency and Crisis Stabilization, Mobile Treatment, and Wraparound Services.

Youth have been increasingly struggling with their mental health, leading to an unprecedented rise in emergency room visits and inpatient psychiatric admissions. It is prudent for mental health providers to be familiar with all services within a continuum of care that can address the early phases of a crisis, allowing youth to remain in the community while being treated. The system of care (SOC) approach has demonstrated positive effects in mitigating the need for hospital-based services. There is a call among experts to integrate SOC concepts during inpatient psychiatric admissions to promote youth remaining within a community after discharge.

"They made me feel like I mattered": a qualitative study of how mobile crisis teams can support people experiencing homelessness.

BACKGROUND: Mobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services. METHODS: We conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent's self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model. RESULTS: Nearly all respondents preferred the MCT model over traditional first responders, highlighting the team's person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation. CONCLUSIONS: In this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT's effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

[Psychological interventions in the field of neurotraumatology during the acute care].

Neurotrauma means head or spine injury caused by an external force. Neurotraumatology care requires coordinated teamwork on the part of specialists, including psychological care as part of the multidisciplinary treatment team. Psychological interventions in the field of neurotraumatology aim to address the psychological consequences and challenges associated with head or spine injury. These interventions play a vital role in crisis intervention, promoting recovery, enhancing quality of life, and supporting individuals and their families in coping with the psychological impact of neurotrauma. Serious physical injuries always cause severe psychological consequences, both in short and long term. A critical accident is a sudden, unexpected, often directly life-threatening event that exceeds the individual's ability to respond and can create a potential crisis response, including suicidal risk, as well as the development of psychological disorders, in most cases acute stress disorder, adjustment disorder and post-traumatic stress disorder. Psychological interventions in neurotraumatology are often provided by a multidisciplinary team that may include psychologists, psychiatrists, social workers, and other healthcare professionals. These interventions are tailored to the unique needs and circumstances of each individual, with the goal of reducing psychological symptomps, promoting psychological well-being, adjustment, and overall recovery following neurotrauma. It is essential that not only patients who have experienced severe physical trauma, but also their family members have access to expert psychological support. This study summarizes psychological interventions during the treatment of neurotaruma patients at the intensive care unit.

Crisis Receiving and Stabilization Facilities: Designing Systems for High-Acuity Populations.

Crisis facilities provide a safe and therapeutic alternative to emergency departments and jails for people experiencing behavioral health emergencies. Program design should center around customer needs which include individuals and families in crisis and key community stakeholders like first responders. Ideally, a crisis system should be organized into a broad continuum of services that ensures care is provided in the least restrictive setting, even for people with high acuity needs, and stakeholders should have a clear understanding of the capabilities of each component facility and the population it can safely serve. This paper provides a framework to help policymakers achieve this goal.

Attending to Persons with Intellectual and/or Other Developmental Disorders in Crisis Settings.

Crisis response is growing across the United States with increasingly broad phone, text, and chat response systems that lead to triaging callers who may be in need of further outreach. This might include deploying a mobile crisis response team and/or referring a caller to a crisis stabilization unit. The information set forth earlier aims to help advance the field and individual practices to ensure that persons with intellectual and/or other developmental disorders receive equivalent care and treatment with information that helps focus on this population's unique features and needs.

Policy, Design, and Critical Reflections on Behavioral Health Crisis Services for People Experiencing Homelessness.

People experiencing homelessness in crisis have unique structural vulnerabilities and social needs, most importantly lack of housing. Ideal crisis services for people experiencing homelessness must safeguard against criminalization and displacement during periods of crisis, prioritize equity, and provide housing interventions alongside mental health treatment at every stage in the crisis continuum. By outlining how to tailor crisis system financing and accountability, service component and capacity, and clinical best practices, the authors aim to provide hope and guidance for communities aiming to create an ideal crisis system for people experiencing homelessness.

Lessons of the Boom: A Playbook for Crisis Centers to Prevent, Survive, and Respond to Active Assailants, Targeted Violence, and Mass Violence.

Modern crisis centers need to be prepared for mass shootings, active assailant incidents, and related forms of targeted violence. While crisis engagement has traditionally been seen as a "right of boom" or post-incident responder, crisis leaders need to prepare their teams to identify people at risk for violence, use tools like Behavioral Threat Assessment and Management to reduce risk in those persons, and prepare their teams for potential incidents in their community. Evidence suggests that acute stressors are a common proximal risk factor for severe violence implying a potential synergy for using crisis services as a tool for prevention of violence.

The Journey Toward 988: A Historical Perspective on Crisis Hotlines in the United States.

This article reviews the historical trajectory of crisis hotlines in the United States from their 1960's inception as 24/7 alternatives to traditional mental health services to becoming "the front door" of the 988 Suicide and Crisis Lifeline in 2022. The Substance Abuse and Mental Health Services Administration's (SAMHSA's) 2001 effort to network, certify, and evaluate crisis hotlines laid the foundation for demonstrating the efficacy of crisis hotlines and their ability to reduce distress and suicidality in people accessing these services. SAMHSA-funded evaluations and the collective leadership of the National Suicide Prevention Lifeline network established evidence-based standards, policies, and practices.

Postcrisis Follow-Up and Linkage to Community Services.

During the postcrisis period, many individuals struggle to transition to available care, often falling through the cracks. This article discusses effective postcrisis approaches that provide rapid access to transitional team-based care using critical time intervention strategies. It also highlights the development of state, county, and funder models for "care-traffic control" to ensure swift linkage to follow-up services, along with new funding models that support intensive community crisis stabilization during the postcrisis period. Emerging crisis systems can leverage these emerging services and approaches to facilitate successful transitions for individuals in need.

Multidimensional Approaches to Quality Measurement and Performance Improvement in the Ideal Crisis System.

This work expands on the National Council for Mental Wellbeing whitepaper Quality Measurement in Crisis Services. The authors present 2 approaches to measure development: The first maps flow through the crisis continuum and defines metrics for each step of the process. The second uses the mnemonic ACCESS TO HELP to define system values, from the perspective of various stakeholders, with corresponding metrics. The article also includes case examples and discusses how metrics can align multiple components of a crisis system toward common goals, strategies for using metrics to drive quality improvement initiatives, and the complexities of measuring and interpreting data.

Youth Crisis: The Current State and Future Directions.

The number of children and youth experiencing behavioral health crisis in the United States is substantially increasing. Currently, there are shortages to home-based and community-based services as well as psychiatric outpatient and inpatient pediatric care, leading to high emergency department utilization. This article introduces a proposed crisis continuum of care, highlights existing evidence, and provides opportunities for further research and advocacy.

Community-Based Mental Health Crisis Response: An Overview of Models and Workforce Implications.

Communities across the United States are working to improve community-based mental health crisis response, with 1 goal being to reduce criminal legal system involvement among individuals with mental illnesses, behavioral disorders, or mental health crises. Existing and recently developed models can generally be divided into non-law enforcement-based response models and law enforcement-based response models. Wide variation exists in terms of staffing, how response teams are called out or dispatched, hours of operation and immediacy of response, and approaches to crisis resolution.

A Systematic Review and Narrative Synthesis Examining the Facilitators and Barriers of Psychological Intervention Delivery in Crisis Resolution Home Treatment Teams.

BACKGROUND: Mental health crisis rates in the United Kingdom are on the rise. The emergence of community mental health models, such as Crisis Resolution Home Treatment Teams (CRHTTs), offers a vital pathway to provide intensive assessment and treatment to individuals in their homes, including psychological interventions. Previous qualitative literature has identified facilitators and barriers to the implementation of psychological interventions within CRHTT settings; however, a synthesis of this literature has not yet been conducted. To address this gap, a systematic review was undertaken with the aim of identifying the reported facilitators and barriers of implementing evidence-based psychological interventions in CRHTTs. METHOD: A systematic review and narrative synthesis were conducted. Studies were included if they examined the implementation of evidence-based psychological interventions in a CRHTT setting. The study population had to be 18 and over and could include healthcare professionals working in CRHTTs, service users of CRHTTs, or family and carers of CRHTT service users. Studies of any formal research methodology were included. Four databases were searched (MEDLINE, CINAHL Plus, Embase and PsycINFO), along with Google Scholar, to identify eligible studies. RESULTS: Six studies were identified, using mixed qualitative and quantitative methodologies, with the predominant focus being the exploration of stakeholder perspectives on care implementation within CRHTTs, encompassing aspects including but not restricted to psychological care implementation. The literature was deemed to be of moderate to high quality. Facilitators included adapting psychological therapies, prioritizing the therapeutic relationship, increasing psychological skills and training of CRHTT staff and psychologically informed CRHTT models. The barriers identified included a medical model bias within teams, resource constraints and elements pertaining to CRHTT services. CONCLUSIONS: Further robust research in this area is imperative. We recommend that future research be implemented in the form of service evaluations and randomized controlled trials (RCTs) and that the principles of implementation science be used to assess and develop the evidence base for psychological intervention delivery in CRHTTs.

Patient's Experiences of a Cognitive Behaviour Therapy Informed Crisis Intervention for Psychosis Delivered in Inpatient Settings: A Qualitative Exploration.

Cognitive behaviour therapy for psychosis (CBTp) should be offered to patients receiving psychiatric inpatient care, yet very little is known about patients' perspectives on this. The aim of this study was to examine patients' experiences of a CBTp-informed intervention delivered in inpatient settings. We recruited 10 participants from the intervention arm of a randomised controlled trial examining the feasibility and acceptability of a CBTp-informed intervention for psychiatric inpatient settings. We undertook semistructured interviews examining their experiences of the intervention and analysed them using thematic analysis. The study was conducted in partnership with a coproduction group of key stakeholders (people with lived experience, family and carers, and clinicians). The intervention was found helpful by almost all participants, and all participants would recommend it to others in similar situations to themselves. The results demonstrated that participants valued the therapist's professionalism and emphasised the importance of the therapeutic relationship. Participants highlighted the importance of the therapy focusing on navigating admission and developing skills to manage the crisis experience so they could return to their normal lives. Participants described challenges to having psychological therapy in the acute crisis context including therapy interruptions and ongoing distressing experiences of psychosis. The study demonstrated the importance of prioritising the therapeutic relationship, that therapy was a valued process to navigate admission and discharge, but that some environmental and patient-level challenges were present. Further research is needed to explore inpatients' experiences of psychological interventions in this setting. TRIAL REGISTRATION: ISRCTN trial registry: ISRCTN59055607.