Introducing a Framework for Crisis Care
The three stages of crisis are fluid, and individuals may transition between or out of these stages at any time. A person may move to wellness/recovery from any stage of crisis. Within this framework there is a need to address all 9 components to effectively provide crisis care. Each of the 9 components are necessarily interconnected – you cannot have one component without the others. To implement these components, human resources, responder wellness, advocacy, stable funding, and training are all considered enablers of this framework. Application of this framework requires ongoing, continuous, critical reflection.
Social Determinants of Health
This refers to the ability to address individuals’ social and material needs and living circumstances. Alternative options, outside of biomedical or hospital-oriented services are required including housing/shelter, food access/security, employment and opportunities for social connection and recreation.
Collaboration
This refers to the need for involvement across sectors, professions, and services coalitions, and formal/informal support groups. An ability to draw on resources and make connections for a range of needs including acute de-escalation, ongoing therapy or counselling, alternative non-medical care options including peer support, housing/shelter services, health services, recreational or social activities.
Choice
This refers to prioritizing consent-based care, where individuals are offered all available options customized to their needs. Where options are prohibitively limited, this is to be explained as part of the consent process. Self-determination is associated with a strengths and empowerment approach and strongly linked to recovery.
Trauma and Equity Informed
This refers to employing trauma-informed approaches in interactions and ensures trauma-informed spaces, inherently embracing anti-oppressive principles. It acknowledges the broad effects of trauma on individuals and their well-being, actions, and circumstances. This includes recognition of distrust of communities in mental health services and the impacts of historical and ongoing trauma.
Relational Care
This is the relational and trust-building aspect of care. It honors the caregiver/recipient relationship with emphasis on empathy, flexibility, dignity, and reciprocity. It extends beyond the transactional approach and is attuned to complex entanglements of dignity-promoting care that
forefront meeting individual needs/desires and instill hope
Spaces of Care
This refers to deep consideration of where care is taking place. Priority factors include adequate physical space, privacy, ability to move away from busy, chaotic spaces, sound, ability to engage with wellness tools, potential for social connection, and updates about next steps.
Accessibility
This refers to the ease with which an individual can obtain mental health supports, services and wellness promoting opportunities through all aspects of care from prevention, connection to supports, and other management of their mental health. This includes timely
access as well as language and cultural accessibility.
Continuity of Care
This refers to care after an initial encounter with a crisis team, hospital, or institution that takes places in a timely manner, ensuring people remain connected between service engagement (including non-medical services), and are not isolated or unsupported in transition to subsequent service usage.
Introducing a Framework for Crisis Care
The three stages of crisis are fluid, and individuals may transition between or out of these stages at any time. A person may move to wellness/recovery from any stage of crisis. Within this framework there is a need to address all 9 components to effectively provide crisis care. Each of the 9 components are necessarily interconnected – you cannot have one component without the others. To implement these components, human resources, responder wellness, advocacy, stable funding, and training are all considered enablers of this framework. Application of this framework requires ongoing, continuous, critical reflection.
The table below provides a description for each icon
1. Relational Care
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How do you currently build trust and empathy with individuals in crisis?
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In what ways could your interactions better honour dignity, flexibility and reciprocity?
2. Trauma and Equity Informed
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How does you current approach account for the potential trauma history of individuals in crisis?
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Are there any gaps in recognizing or addressing the impact of historic or ongoing trauma?
3. Choice
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How often do you provide individuals with options to prioritize their self-determination?
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What practical steps can you take to ensure that consent and empowerment are key components in the care you provide?
4. Accessibility
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Are the services and resources you provide easily accessible, including considerations for language, culture and physical spaces?
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What barriers might individuals face when accessing your care and how can this be reduced?
5. Community Engagement
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How well do you collaborate with other sectors, services and community organizations to provide holistic care?
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What opportunities exist to involve community voices more effectively in shaping a crisis response?
6. Continuity of Care
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How do you ensure individuals remain supported after the initial crisis intervention?
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What improvements could be made to strengthen connections between services and reduce isolation for individuals in crisis?
7. Social Determinants of Health
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When you interact with people in crisis, do you ever reflect on the broader systemic factors at play impacting their situation outside of their individual story and decisions?
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How do you address the broader social and materials needs of those you service (e.g. housing, food, security, social connection)?
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Are there alternative or nontraditional resources you could integrate into your practise to better meet these needs?
8. Spaces of Care
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How would you describe the typical environment where you provide care (ambulance, hospital, community spaces)?
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What changes could you provide to create a calmer, more supportive environments during crisis interventions?
9. Accessibility
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How do people typically access the services you provide, and from your services, how accessible are other supports?
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Are there aspects of accessibility such as language and cultural accessibility that are more challenging for people? Are there ways this could be improved upon?
Scenarios
Below are several scenarios for you to consider.
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Choose several of the following scenarios.
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With the 9 components of the framework in mind, consider what the response you provide could look like, accounting for the multiple components of the framework.
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Can you identify how these different aspects are integrated? For example: from a trauma and equity informed approach, you recognize that the person experiencing crisis is hesitant to interact with you, and you’re aware it may be due to previous negative interactions with first responders or the health system.
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From a relational care aspect, you aim to build trust with the person, letting them know that you’d like to know what they feel they need at this time, and after listening carefully, you offer several possible choices that you can support with that could meet some of those needs.
SCENARIO 1
A first responder is called to a home where a teenager is experiencing a mental health crisis. The family is present but overwhelmed. The teenager refuses to speak and avoids all eye contact.
SCENARIO 2
A first responder encounters an individual who is unhoused who has experienced a toxic drug overdose. After stabilizing the individual, the responder discusses the next steps. The individual is hesitant to go to the hospital, because of previous negative experiences.
SCENARIO 3
A responder arrives at a low-income housing complex to assist an individual in distress. The caller indicated that the person was having a mental health crisis. The individual speaks limited English and is struggling to understand the responder’s instructions. The individual's teenage daughter tries to translate but becomes emotional, adding to the difficulty.
SCENARIO 4
A paramedic responds to a call for someone experiencing crisis, and upon meeting the person and their family member, find they are reluctant to speak to the paramedics. They look somewhat agitated and upset that the paramedics are there, but are in evident need of further support. If conversation continues, the person shares a negative experiencing with police and paramedics in the past and expresses fear of hospitals due to past traumatic experiences.
SCENARIO 5
An individual is experiencing crisis at a local community shelter. The person is unhoused and has limited social supports. The situation requires input from social workers, medical staff, and housing advocates to fully address the individual’s needs.
SCENARIO 6
One week ago a paramedic a middle-aged man in distress in a public park. Paramedics transport the man to a hospital for evaluation. Today, the paramedic has been called back to the individual out front of a local business. The paramedic learns that the individual was discharged without a follow up plan and is now experiencing another crisis.
SCENARIO 7
A responder arrives at a busy train station where a person in crisis is sitting on the floor, surrounded by a noisy crown. The individual is visibly distressed covering their ears and unable to communicate effectively.
SCENARIO 8
A first responder assists an individual in crisis who is unhoused, experiencing food insecurity, and whom they have supported at least every few weeks. The person has shared that they lost their job and have no other supports.