No description available.

There is a distinct lack of research into the concept of acute mental health crisis. Without investigating the concept of crisis itself, it is not possible to appreciate the attributes of crisis so that it can be measured. This has hampered the development of good psychometric tools for crisis. The aim of this research was to develop the first standardised, valid and reliable measure for the assessment of people presenting to Crisis Resolution and Home Treatment (CRHT) teams. This research utilised qualitative and quantitative research techniques to develop a crisis measure starting with a comprehensive investigation into the concept of acute mental health crisis to identify an item pool and clinically credible item rating scale. A prototype crisis measure was developed and piloted in two NHS CRHTs and data collected. This data was analysed to identify the key areas of crisis assessment (the subscales), a flexible rating scale and scoring system creating a measure named the Crisis Risk and Adaptive Functioning Tool (CRAFT). The CRAFT provides patient crisis profiles highlighting areas of strength, resilience, weakness and vulnerability. A thorough investigation of crisis was completed with CRHT staff and patients through interviews and focus groups. An initial 143 item pool and clinically credible item rating scale were identified and developed into a prototype pilot crisis measure. This measure utilised a flexible rating approach encapsulating both risk and protective factors believed to reflect clinical practice. The measure was piloted and the data analysed to assess the structure of the crisis measure’s item pool using the statistical techniques of Principal Component Analysis (PCA) and Rasch analysis. These analyses resulted in a 66 item measure with 8 unidimensional subscales including; 1) Crisis Recovery Indicators, 2) Adaptive Decision Making, 3) Risk of Harm to Self, 4) Mediating Factors, 5) Daily Structure, 6) Risk of Harm to Others, 7) Feelings and Affect, and 8) Basic Needs. The total variance explained by these 8 subscales was 67.6% with excellent internal reliability as indicated by a Cronbach’s alpha coefficient of 0.98 (p<0.001) and temporal reliability indicated by Spearman’s correlation of 0.971 (p<0.001, one tailed). This suggests that this measure has a strong internal structure and provides stable outcomes over time at both the subscale and global overall measurement levels. Receiver Operator Characteristic curve analysis supported the identification of cut-offs to indicate low, moderate and high levels of crisis and were shown to have good levels of sensitivity and specificity for the crude discrimination between individuals who require CRHT treatment and individuals who do not require CRHT treatment (sensitivity 0.89 and specificity 0.73) and for accurately discriminating between the basic treatment levels of low, moderate and high (sensitivity 0.80; specificity 0.69). One of the great advantages of utilising the Rasch model is that it supports the identification of key characteristics from an item pool. Application of the subscales and the overall measure to the Rasch model identified items that were most representative of underlying constructs and risk, highlighting items of essential essence for assessing crisis in the context of community treatment. These items may act as useful clinical and risk indicators for community assessment. After considering the evidence from the PCA and Rasch analysis for the underpinning construct, the measure was named the Crisis Risk and Adaptive Functioning Tool (CRAFT) to encapsulate both the risk and adaptive functioning (coping and management) aspects measured by the tool. There are a number of clinical implications resulting from the development of CRAFT for the assessment of crisis. This research clearly identifies 8 key areas for crisis assessment and the specific items that describe them. This promises to be a powerful clinical tool as it clarifies the main areas of concern and importance for crisis assessment and provides mental health professionals with a means of assessing and monitoring patients experiencing crisis. In addition to the clinical benefits offered by the CRAFT, it provides an approach to assessing and monitoring crisis to support further research in the area of acute mental health crisis. This research offers significant steps towards the development of a quality measure for crisis assessment. However, it is acknowledged that the process of measurement development is never complete. It simply evolves over time with the aim of coming closer to the valued direction.

Indiana University-Purdue University Indianapolis (IUPUI) / The criminalization of mental illness has drawn and kept a disproportionate number of people living with mental illness in jails and prisons across the United States. The criminal legal system is ill-equipped or unequipped to provide meaningful mental health care. Police often serve as gatekeepers to the criminal legal system in the midst of encounters involving people living with serious mental illness. The literature that examines police decision-making amid these highly discretionary encounters has been primarily situated in post-positivist, quantitative methodologies focused on police perspectives. There is a dearth of research with the direct involvement of people living with serious mental illness that employs more advanced qualitative methodologies. The purpose of this study was to understand the lived experience of police encounters from the perspective of people living with serious mental illness through multi-level analysis of the interpersonal and structural contexts which underpin these encounters. This critical phenomenological study used interpretative phenomenological analysis as process. A sample of 16 adults were recruited using purposive and snowball sampling and completed semi-structured interviews. The findings reported two descriptive areas for participants—aspects of serious mental illness and contemplations of power. The findings also included the interpretive analysis organized around six themes that emerged regarding the lived experience of police encounters: (a) significant context, to include serious mental illness, was made invisible, (b) the carceral response to serious mental illness and interpersonal issues, (c) law enforcement’s power to force submission, (d) facets of escalation, (e) law enforcement encounters lacked essential care, and (f) law enforcement encounters served as a microcosm of the criminal legal system. The implications of the study’s findings on police encounters as they are currently framed in the largely post-positivist, quantitative body of research are discussed. In addition, the current wave of national police response models and reform are considered and connected to implications for social work practice. Finally, culminating in the findings’ implications for a growing edge of critical phenomenology that incorporates intersectionality and disciplinary power and the central role of an abolition feminist praxis at the nexus of mental health, crisis response, and collective care.

No description available.

Scarce community mental health resources have led to people in crisis (PIC) overusing the emergency department (ED) and encountering police more frequently. To divert PIC from the ED and criminal justice system, and support them in their community, police services have implemented crisis response teams (CRTs). CRTs refer to police, health and mental health crisis response. Evidence of CRTs’ effectiveness in achieving their desired outcomes is limited, mixed, and/or anecdotal. I completed three studies using various theoretical and methodological approaches, which included: (a) a critical interpretative synthesis (CIS) of the conditions under which CRTs are formed, their features, and their outcomes; (b) a policy analysis using a case study design to examine how and why a CRT model was adopted in Hamilton, Canada; and (c) a what’s the problem represented to be (WPR) critical policy analysis of why police are implicated in crisis response. The CIS presents a conceptual framework depicting how unresolved structural conditions produce system- and individual-level challenges. Second, the case study examines the mobile crisis rapid response team (MCRRT) development in Hamilton. The analysis shows that initiatives that incrementally expand on the boundaries of existing programs are likely to be adopted. Third, drawing on WPR, we excavate problem representations within policy and policy-related texts to understand why police-based CRTs are expanded in Ontario. When mental health is framed in terms of safety and implicated within discourses about risk and danger police intervention is legitimized. Collectively, these studies provide a theoretical framework connecting structural, system, and individual factors most relevant to CRTs; demonstrate that an incremental approach to CRT adoption did not disrupt existing system arrangements; and problematizations within government policies that legitimize police in mental health crisis response. / Thesis / Doctor of Philosophy (PhD) / Since deinstitutionalization, during which mental health patients were discharged into the community, this population has had more frequent encounters with police, contributing to criminalization and tragedies. They have also increasingly sought mental health crisis support in emergency departments. Police, health, and mental health crisis response teams (CRTs) have been implemented as an alternative response to people with mental health issues who are in crisis. To date, CRTs have been widely implemented but with little, mixed, and/or anecdotal evidence demonstrating their effectiveness. This dissertation contextualizes information about CRTs by presenting (a) a conceptual framework on CRTs, outlining the structural, system, and individual conditions under which CRTs are formed, their features, and outcomes; (b) a case study that examined under what conditions a CRT was developed and implemented in Hamilton, Canada; and (c) a critical discourse analysis of CRTs.

Thesis (M.Sc.)--Memorial University of Newfoundland, 1998. / Typescript. Bibliography: leaves 97-106.