Understanding Crisis to Inform Crisis Response: Community Perspectives From a Qualitative Ethnographic Case Study.

Responses to crisis in the community have gained significant attention, recognizing potential life and death consequences of such responses, with particularly significant impacts for systematically marginalized communities and individuals. Dominant conceptualizations of crisis have been critiqued as medicalized and focused primarily on what medical care an individual in crisis receives, overlooking contextual and structural issues. This paper explores descriptions of crisis and considers how understandings of crisis align or misalign with the responses to crisis that exist within communities in Ontario, Canada. Utilizing a critical qualitative ethnographic case study approach and informed by a critical mental health lens, semi-structured interviews (n = 53), open-ended surveys (n = 60), and document analysis were conducted to gather perspectives from community members with lived experience, community-based organizations, and acute-care institutions such as paramedicine, police services, and emergency departments. Crisis was described as: broad, inclusive and self-defined; impacted by structural living conditions; resulting from barriers to access and the misfit of services to needs; and as resulting of the conditions of care. These findings contribute to a conceptualization of crisis that considers contextual, structural, and systemic issues impacting crisis. We discuss the importance of moving beyond a biomedical reductionist understanding of crisis and the ways in which we can challenge and shift medicalized and carceral systems of crisis care. As attention increasingly shifts towards the development and expansion of crisis-related responses, it is crucial to ensure that these responses adequately meet people's needs and, where possible, prevent further crises.