Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review

OBJECTIVE

To review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders.

DESIGN

A systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants' experiences were included.

DATA SOURCES

MEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed.

DATA EXTRACTION AND SYNTHESIS

Two reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed.

RESULTS

We identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where 'frequent attenders' are repeatedly let down by mental health services.

CONCLUSION

Lack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

OBJECTIVE

To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond.

DESIGN

A scoping review using Arksey and O'Malley's five-stage framework. Papers were analysed using thematic analysis.

DATA SOURCES

MEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand.

RESULTS

Searches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored.

CONCLUSIONS

To the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.

Odnos reševalcev do uporabe različnih oblik prisilnih ukrepov

Uvod: Prisilni ukrepi se v predbolnišničnem okolju pogosto uporabljajo. Namen raziskave je bil raziskati pojavnost in odnos reševalcev do prisilnih ukrepov. Metode: Vprašalnik je izpolnilo 178 reševalcev. Vsi sklopi vprašalnika so dosegli primerno zanesljivost (Cronbach alfa > 0,8). Podatki so bili analizirani z opisno statistiko, t-testom, testom ANOVA in Pearsonovo korelacijo ob upoštevani statistični značilnosti p < 0,05. Rezultati: S prisilnim ukrepom se je že srečalo 165 (92,7 %) reševalcev. Ženske reševalke se v primerjavi z moškimi reševalci počutijo manj varne (t = 3,243, p = 0,03) in se bolj strinjajo s posredovanjem policije (t = –0,572, p = 0,03). Na terenu se najpogosteje uporablja vezanje s policijskimi lisicami, tj. s t. i. vezicami (x = 3,30, s = 1,15). Agresija, usmerjena proti drugim (x = 4,22, s = 0,86), agresija, usmerjena proti sebi (x = 4,23, s = 0,76), in nemir (x = 3,23, s = 0,98) so najbolj upravičeni razlogi za uporabo prisilnih ukrepov. Reševalci menijo, da potrebujejo več znanja s tega področja (x = 3,90, s = 1,01). Diskusija in zaključek: Reševalci navajajo podobne vzroke za uporabo prisilnih ukrepov, kot jih v že predhodnih raziskavah navajajo zaposleni v bolnišnicah. Toda mnenje reševalcev o uporabi teh sredstev je negativno, z njihovo uporabo se v večji meri strinjajo samo v primeru pacientov z agresivnim vedenjem. Pri svojem delu se reševalci počutijo ogrožene. Glede uporabe prisilnih ukrepov potrebujejo usposabljanje in izobraževanje.