Crisis resolution and home treatment for individuals with complex emotional needs: a meta-ethnographic synthesis

Abstract

BACKGROUND: A great deal of research already exists around the experiences of, and responses to, individuals with Complex Emotional Needs (CEN), seeking care in a mental health crisis. Fewer studies, however, focus upon this specifically within the context of Crisis Resolution and Home Treatment (CRHT).
OBJECTIVES: A qualitative evidence synthesis of existing literature was used to develop a comprehensive understanding of how mental health crisis care is experienced by both those giving and receiving care within CRHT.
DESIGN: Findings from published qualitative primary research articles were synthesised using a meta-ethnographic approach.
METHOD: Six health-related databases were searched for qualitative primary research studies, published between 2003 and 2022. Peer-reviewed journal articles considering both staff and Service Users experiential accounts of home-based mental health crisis care were systematically selected for their ability to contribute to understanding of this topic and included in this review.
RESULTS: From the studies reviewed, it appears that both the giving and receiving of care within CRHT is broadly experienced across four inter-related domains:
a) ‘Contextual’ (concerning the role of CRHT in the wider systems within which teams operate)
b) ‘Functional’ (concerning the organisation of everyday CRHT)
c) ‘Relational’ (concerning the importance of interpersonal connections)
d) ‘Decisional’ (concerning decision-making within CRHT, with a particular emphasis upon risk)
Whilst Service Users and Staff Members discussed their experiences across all four of these domains, Service User accounts focused more upon the relational, indicating the importance of this domain to their experience of care. Where experiential accounts of those with CEN were considered here, these were not always positive; diagnostic labels, often acting as barriers to accessing CRHT and increasing the risk of invalidation.
In contrast, Staff member accounts appeared to focus more upon the contextual issues; organisational anxieties, expectations of others and resources, impacting upon risk decisions especially when caring for individuals with CEN.
IMPLICATIONS: There is limited research consisting of experiential accounts of care giving and receiving within the context of CRHT, specifically for people with CEN. To fully understand the potential barriers and facilitators of care for this population within CRHT, further research is needed.