Introduction: This thesis contains three studies which are embedded within the larger CRIMSON trial; an individual level, randomised control trial comparing joint crisis plans with treatment as usual for people with severe mental illness. This thesis presents sub-analysis from CRIMSON, testing hypotheses about ethnic minorities only within the context of the wider trial. Recruitment and utilisation of the intervention by ethnic minorities is also investigated.Methods: The joint crisis plan intervention documented the service users’ treatment preferences for the event of a future crisis. The plan was formulated collaboratively by the service user and their clinical team and was negotiated by an independent facilitator. The settings for the trial were community mental health teams across three sites in England. The hypotheses tested were that compared to receiving treatment as usual, the intervention group would experience fewer compulsory hospital admissions, fewer psychiatric hospital admissions and an improved working alliance with their care coordinator. Following a systematic review, strategies were implemented to overcome barriers to recruiting ethnic minorities into the CRIMSON trial. Diary entries were maintained in the Manchester/Lancashire site detailing attempts to overcome barriers encountered with the recruitment of ethnic minorities. Content analysis was carried out on the completed joint crisis plans to assess culturally relevant statements made regarding service users’ mental health and future treatment.Results: In the sub-analysis 182 participants were randomised (94 experimental, 88 control group). No evidence of treatment effect was seen for compulsory hospital admissions (OR 0.87, 95%CI 0.43-1.77, p=0.71) any psychiatric admissions (OR 1.18, 95%CI 0.62-2.24, p=0.62) or service user rated working alliance (B=2.69, 95%CI -2.95-8.32, p=0.35). Additional sub-analysis found differential effects of the intervention on specific ethnic groups, with a reduction in overall admissions observed for black participants and an increase in admissions for south Asian and white British service user on any admission. Strategies for reducing barriers to participation into the research from ethnic minorities were implemented and 50% of south Asian and black service users who were eligible for CRIMSON were recruited. 28% of south Asian and black participants made culturally relevant statements within their joint crisis plans. This figure was significantly higher for south Asian (44%) compared to black (20%) participants (p=0.03).Conclusions: This thesis suggests that joint crisis plans may have a differential effect on people from different ethnic groups, for reasons that at present we do not understand. This is interesting because it emphasises the importance of analyses that look at ethnic minorities and the way that they may help elucidate the effects of complex interventions. It also suggests that different ethnic minorities may react in different ways. This thesis certainly supports the value of efforts to recruit ethnic minorities. It is recommended that future work around joint crisis plans should take a qualitative approach to aid the understanding of what lies behind these apparent differential effects.

The importance of providing appropriate crisis intervention to individuals and families from diverse backgrounds is an often overlooked aspect of service provision. In particular, school-based crisis intervention has only recently begun to address this issue. This study reviewed state mandated school crisis plans, state directives for crisis plans, and state resources to assist school districts in developing crisis plans. The content of these materials was examined to determine the extent and type of coverage given to student diversity, particularly cross cultural considerations. Materials were obtained from state department of education internet sites and from the state offices of Safe and Drug Free Schools. More specifically, materials included school crisis plans, state legislation related to crisis plans, and key internet websites linked to state departments of education. Representatives from all 50 states were initially contacted. Materials from 40 states were obtained. Thirty-three of the 40 states' crisis planning materials mentioned topics related to cultural sensitivity and/or student diversity. After reviewing and summarizing this information, 3 areas of service related to cultural sensitivity were identified as the most frequently reported topics: (a) working with students with mental and physical disabilities; (b) tapping into community resources representing diverse cultural groups; and (c) cross-cultural language and communication issues. Information related to cross cultural sensitivity was typically embedded in the document, not directly referred to in a section titled to indicate this topic. Unlike other topics such as violence, bomb threats, media, and suicide, cross cultural issues related to diversity did not appear to be a high priority in states' suggested and mandated crisis planning materials.

Despite the effects of natural disasters on small business owners, the owners' communication strategies to alleviate loss to their companies' profitability remain problematic. The purpose of this qualitative descriptive multiunit case study was to explore what communication strategies some small business owners developed and implemented for facilitating resuming their business operations after a natural disaster. The targeted population consisted of 2 small business owners located along the Belmar Boardwalk in Belmar, New Jersey. The conceptual framework for this study was Coombs' situational crisis communication theory. The case data collected were from semistructured interviews and company documents. Employing member checking and methodological triangulation increased the assurance of the study's credibility and trustworthiness. The data analysis consisted of separating the data into groupings, identifying major groupings, assessing the information within the major groups, and developing thematic interpretations. The 4 validated themes that emerged were communication, community, disaster recovery, and stakeholders (employees). The findings from this study may contribute to social change by providing communication strategies that small business owners can use to mitigate losses from disasters, and facilitate businesses' and communities' recovery for reducing further losses.

In my diploma thesis entitled Implementing the Gold Rule of Morality in Crisis Planning for Population Protection, I will try to draw on the ideas and conclusions of my bachelor thesis, in which I investigated whether members of the Integrated System Can use the golden rule of morality in an emergency. I have come to the conclusion that the members of the individual components of the integrated rescue system are guided by the valid legislation and orders of the commander of the intervention. Nevertheless, they would welcome in certain situations the possibility of deciding according to the golden rule of morality, which briefly tells us: "I do not want to do the other to you." Translated into situations in the event of an extraordinary event may mean deciding in tedious situations so, as if you were the Rescued and not the savior. The aim of my thesis is to find out whether it is possible to implement this idea in the crisis plans themselves and, above all, whether the intervening members of the integrated rescue system themselves would use this rule in certain situations. The association of two seemingly incompatible worlds seems at first glance absurd, but research and interviews with individual members of the integrated system have convinced me that the philosophical questions and the name of Imanuel Kant can very closely mingle with the world of extraordinary events and the salvation of Human lives, health and property of the population. I would very much like to work with this bachelor thesis together with my previous bachelor thesis, tried to create a unified whole as an idea that can motivate us to think whether it is necessary to change the current state of legislation or whether the legislation itself is set as a form of golden rule of morality .

The purpose of this study is to understand how companies in the retail industry altered the disposition of their marketing during the Covid-19 outbreak and whether crisis management plans contributed to the producers' choice of disposition. To conduct the survey, semi-structured interviews were held with three retail companies, which are categorized as “large companies” according to the Swedish Agency for Economic and Regional Growth. The respondents consisted of senior managers from the marketing department of within each firm. The results show that crisis management plans contributed to companies' ability to identify new opportunities and counter threats, while dynamic functions contributed to their ability to respond to the crisis in an effective way by their choice of marketing disposition. Furthermore, the respondents stated that crisis management plans are not relevant until the outcome of the crisis is more clear. Lastly, the results show that most companies saw opportunities to reach more potential consumers on the internet with the new migration of pensioners on the internet, when the pandemic forced society to become more active on the internet. / Denna studies syfte är att skapa förståelse för hur producenter inom detaljhandelsbranschen ställde om sin disponering av marknadsföring under Covid-19 samt huruvida krishanteringsplaner bidrog till producenternas val av disponering. För att genomföra undersökningen utfördes semistrukturerade-intervjuer med tre stycken detaljhandelsbolag, vilket kategoriseras som “stora företag” enligt tillväxtverket. Respondenterna bestod av högt uppsatta chefer från marknadsavdelningen inom respektive företag. Resultatet visar att krishanteringsplaner bidrog till företags förmåga att identifiera nya möjligheter och motverka hot, samtidigt som dynamiska funktioner bidrog till att bemöta krisen på ett effektivt sätt genom deras val av disponering avseende marknadsföring. Vidare, redogör respondenterna att krishanteringsplaner inte är av relevans förrän man kan tydliggöra utfallet av den pågående krisen. Slutligen, visar resultaten att majoriteten av företagen såg möjligheter att nå ut till fler potentiella konsumenter på internet då pandemin tvingade samhället att bli mer aktiva på internet. I synnerhet, har man sett en drastisk ökning av pensionärer på internet vilket skapat nya möjligheter för företag.

Les situations de crise sont fréquentes chez les personnes ayant des troubles de santé mentale. Plusieurs interventions ont été développées pour agir en prévention, dont les plans de crise reconnus comme particulièrement efficaces pour diminuer le recours aux mesures coercitives. Dans la littérature, plusieurs modèles de plans de crise sont proposés et incluent entre autres le plan de sécurité, le plan de crise conjoint et les directives anticipées. Un examen de ces différents plans permet de constater qu’ils ont des buts et des contenus très semblables. Basé sur la méthodologie proposée par le Johanna Briggs Institute (2020), une revue de la portée a été conduite dans l’objectif de dresser l’état des connaissances sur les plans de crise en santé mentale adulte. Une stratégie de recherche documentaire a été conduite sur six bases de données (CINAHL, PubMed, Medline, EMBASE, PsychINFO, and Cochrane) et a permis d’identifier 2435 articles. Parmi ces derniers, 122 textes complets ont été évalués et 78 ont répondu aux critères d’inclusion de l’étude. Ensuite, la qualité méthodologique des articles sélectionnés a été évaluée et les données ont été extraites de façon indépendante par deux étudiantes à la maitrise. L’analyse de contenu a été réalisée, puis les résultats préliminaires ont été présentés, discutés et validés avec un patient partenaire ayant vécu des crises en santé mentale. Une typologie des plans de crise a été identifiée selon 1) les plans de crise légaux et 2) les plans de crise formels. Également, cinq modalités pour la complétion des plans de crise ont été identifiées : les sections, le moment, les étapes de complétion, les personnes impliquées et la formation des acteurs.trices clés. Les retombées de l’intervention sont concordantes avec le but principal des plans de crise, soit la prévention de la crise. Or, les retombées les plus identifiées dans la littérature sont davantage liées au rétablissement de l’usager.ère et semblent indiquer que les plans de crise pourraient représenter une intervention permettant d’opérationnaliser le rétablissement dans les soins en santé mentale. Les futures recherches empiriques devraient cibler le développement des connaissances sur les modalités à privilégier dans l’objectif de guider les milieux cliniques dans l’implantation des plans de crise. / Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans, which are recognized as particularly effective in reducing coercive measures. In the literature, several types of crisis plans have been proposed, including the safety plan, the joint crisis plan and advance directives. A review of these plans suggests that they are very similar in purpose and content. Based on the methodology proposed by the Johanna Briggs Institute, a scoping review was conducted with the objective of mapping the state of knowledge on crisis plans in adult mental health services. A literature search strategy was conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO, and Cochrane) and yielded 2435 articles. Of these, 122 full text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were then critically appraised using the Johanna Briggs Institute appraisal tools, and date were extracted my two master’s students. Content analysis was performed, and preliminary results were presented, discussed, and validated with a patient partner who has experienced mental health crises. A typology of crisis plans was identified according to 1) the legal crisis plan, 2) the formal crisis plan. Five modalities were identified for its completion: sections, timing, creation steps, people involved, and training of key actors in writing a crisis plan. The outcomes of the intervention are consistent with the main objective of crisis plans, which is to prevent a crisis. However, the most identified outcomes focused on the service user’s recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.