A community informed, integrated approach to crisis care response

Background: Responses to mental health crises have recently gained significant attention, recognizing that these interactions may have substantial, potentially life and death consequences for those already in distress. Standard responses to mental health emergencies may involve 9-- dispatchers, paramedic services, police services, hospital emergency department (ED) services and a range of other community services. Demands for emergency mental health care in Canada and internationally have increased, and many people experience repeat visits to the ED and have needs that remain unmet. Of particular focus are individuals of lower socioeconomic status, Black and Indigenous communities, racialized people, 2SLGBTQ+, and immigrant communities. Members of these communities are disproportionately affected by intersecting structures of oppression that negatively affect their mental health and are at greater risk for negative interactions with emergency services. Approach: Framed by critical theory, we aimed to identify what is working well, what is needed, and the core components of a best practice approach to mental health crisis care. Specific to this approach was an intentional engagement with the needs of underserved communities who continue to have disproportionately negative interactions with crisis care systems, and an intent to consider non-medicalized approaches to mental health support, including those that account for the social determinants of health. The research team, partnered with Middlesex-London Paramedic Service and TAIBU Community Health Centre, conducted a critical qualitative ethnographic case study exploring emergency mental health response in Ontario, Canada. Semi-structured interviews (n=53), open-ended surveys (n=60), and document analyses were carried out from January 2022-December 2023. Interviews and surveys were conducted across various sectors. Participants included people who have required crisis support needs, health care management, and frontline workers from community-based organizations, paramedic services, police services, and hospital emergency department staff. Data were coded and analyzed using reflexive thematic analysis. Results: From these data, key themes were identified, and 9 key components of crisis care responses were developed into a framework. This framework was co-developed with community partners, and additional feedback from community organizations was sought, and service users were involved in reviewing the framework. This feedback was integrated into the final framework which includes pre-crisis, crisis, and post crisis phases. Integral to the application of this framework is ongoing, continuous critical reflection on all 9 components. The key components of this model include: . Relational care 2. Choice 3. Accessibility 4. Spaces of care 5. Social determinants of health 6. Collaboration 7. Community-engagement 8. Trauma-informed, and 9. Continuity of care. Implications: The model holds the potential to diversify mental health crisis responses and make metal health services more inclusive and sensitive to the needs of the specific community in which they are deployed. Application of this framework requires ongoing, continuous, critical reflection of all nine components, and aims to inform ongoing assessment of existing crisis care responses and to inform development of new response models of crisis care.