'Beyond places of safety' - a qualitative study exploring the implementation of mental health crisis care innovations across England

BackgroundMental health acute and crisis care consumes a large share of mental health budgets internationally but is often experienced as unsatisfactory and difficult to access. As a result, there is an increasing move towards developing innovative community crisis services, to improve patient experience and relieve pressure on inpatient and emergency services. This study aims to understand what helps and hinders the implementation of innovative mental health crisis care projects in England.MethodsUsing a qualitative approach, 18 interviews were conducted with crisis care service managers exploring their experiences and views of the development and implementation of their service developed with support from an English national capital funding programme. A framework analysis was conducted informed by implementation science.ResultsKey facilitators to implementation of innovative crisis services included bottom-up development, service user involvement, strong collaborative working, and leadership and management buy-in. Key barriers that affected the projects implementation included the complexities of crisis care, workforce challenges and resourcing issues.ConclusionThere is a recognised need to improve, update, and innovate current crisis care offers. Results from this study suggest that a range of models can help address the heterogenous needs of local populations and that new approaches can be implemented where they utilise a whole-systems approach, involving service users and relevant professional stakeholders beyond mental health services in planning and developing the service.

Automated summary

Mental health acute and crisis care consumes a significant portion of mental health budgets worldwide, but is often deemed unsatisfactory and difficult to access. This study aims to understand the factors that aid or hinder the implementation of innovative mental health crisis care projects in England. Findings suggest that bottom-up development, service user involvement, collaborative working, and leadership and management buy-in are key facilitators to implementation, while complexities in crisis care, workforce challenges, and resourcing issues act as barriers.