The Reciprocal Insecurity Paradox: A phenomenological analysis of the crisis encounter between the mental health nurse and service user with complex emotional needs

While research is emerging, there remains an inadequate focus upon the experiences of those delivering and receiving care specifically for service users with complex emotional needs (CEN) within Crisis Resolution and Home Treatment (CRHT) settings. This study therefore utilised hermeneutic phenomenology to examine the lived experience of both those providing and receiving care within CRHT settings. Data were gathered via semi-structured interviews with 14 participants (Seven mental health nurses working within CRHT settings, and seven service users with CEN who have received CRHT intervention). Transcripts were analysed using van Manen’s hermeneutic phenomenological reflective method. A synthesis of participant accounts revealed several areas of convergence across the two groups, thus highlighting those ‘core structures’ of mental health crisis care as lived by participants in these encounters. Fears arising from structural vulnerabilities were illuminated as the eidos (or the ‘essence’) of the crisis encounter in CRHT settings and at the heart of the crisis encounter, a central phenomenon of reciprocal insecurity is illuminated, whereby both parties' attempts to achieve a sense of personal safety inadvertently threatens that of the other. Findings highlight an urgent need for hermeneutic mediators; structures that provide the space and containment necessary for both parties to feel safe.