mental health crisis case study

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Newbigging K, Rees J, Ince R, et al. The contribution of the voluntary sector to mental health crisis care: a mixed-methods study. Southampton (UK): NIHR Journals Library; 2020 Jul. (Health Services and Delivery Research, No. 8.29.)

The contribution of the voluntary sector to mental health crisis care: a mixed-methods study.

Chapter 4 experiences of a mental health crisis.

This chapter starts with participants’ experiences of a recent MH crisis and considers the relevant context and factors they identified, what they felt their needs were and the impact of the crisis on their lives. The different conceptions of a MH crisis by the various participants are compared. Although this chapter primarily draws on data from WP4, these findings are presented first as a reference point for reporting our subsequent findings.

• Experiencing a mental health crisis

More than half of the service user participants reported a previous experience of having a MH crisis ( n  = 34), although a number of people were unsure whether this was their first crisis or not ( Figure 1 ). There was a higher percentage of people in site C (36%) reporting it as their first crisis, reflecting recruitment mainly via the VS, than in the other sites, where participants were also recruited via the NHS. More than half of the sample (58%) had been accessing VS support for less than a year ( Table 9 ). By contrast, two-thirds (67%) had been using MH services for more than 3 years, although this was particularly the case in sites B and D.

Crisis experience of participants in the study sites.

Length of contact with VS or public sector services by participants in the sample

Service user participants described a wide variety of crisis experiences across the sites. A distinction can be drawn between (1) ‘a situational crisis’, with service user participants describing their experience of crisis as a ‘one-off’ event or a response to a specific situation (e.g. severe work stress or relationship break-up), (2) ‘a traumatising crisis’, when the crisis was associated with previous trauma (e.g. abuse, assault or loss) and was triggered by a specific situation resonant of this (e.g. an abusive relationship), and (3) a crisis as an element of ongoing MH issues (e.g. depression and bipolar conditions were commonly mentioned). For some people, it was a combination of events or situations coupled with pre-existing trauma or MH issues. Some participants also said that they could not identify a particular trigger. The following sections outline aspects of the experience that were identified.

‘Falling into a million pieces’

For the majority of service user participants, the crisis experience was described as ‘overwhelming’, as bringing a sense of ‘falling apart’ and as a ‘dark place’ to be:

I just couldn’t focus, face anything. I just literally shut down, became very scared, the voices telling me that I’m better off dead, and it was a horrendous 3 years. And then she left, which was even worse because I had nothing then. ASU2

This experience of being overwhelmed, losing control and uncertainty about life was likened to ‘falling into a million pieces’ and ‘a car crash’, conveying a sense of interruption and disruption. The range of experiences described included extreme anxiety, profound sadness, ‘paranoid beliefs’ and suspicions about other people, hearing voices, self-harm, suicidal feelings and isolation:

It’s like a very, very dark place to be and . . . your nervous system will collapse and [this] means you become more anxious, you become like a jelly and . . . it’s a hard time. BSU8

Sometimes, the experience was accompanied by intense feelings of anger or exhaustion:

It’s like where it can go from 0 to 100 in a split second . . . where all the coping mechanisms that I’ve had and the help and support just suddenly seem to disappear. I end up on this track that is destructive and . . . then I feel trapped and that’s when it all goes to an enormous crisis. CSUG

For some, exhaustion reflected the effort that was needed to appear to be coping:

My teachers thought I was fine because during school I would just get on with my work. After school I used to just be really depressed. I couldn’t cope with the anxiety . . . I was panicking so I was crying, struggling breathing because I wasn’t breathing properly. I felt overwhelmed. ASU4

Rarely, the crisis experience was accompanied by feelings of elation and happiness, as was the case for one person who felt they had special powers and could fly.

Suicidal feelings and self-harm

Suicidal feelings and self-harm were commonly described and were often cited as the reason for contacting a service (both the VS and the public sector). Self-harm was usually repeated and, for some participants, was a way of coping and, therefore, was not seen as a crisis:

I wouldn’t call Crisis or I wouldn’t call a hotline to say I really want to self-harm, can you help me stop. I wouldn’t really be that bothered, to be honest. I wouldn’t consider that a crisis. ASU5

Suicidal feelings often persisted or emerged at different times; they were rarely an isolated experience:

I got into severe depression and had severe suicidal thoughts constantly. DSU9

A number of people described having made a suicide attempt previously:

You have thoughts in your head saying suicide or you’re going to do something to yourself or hurt yourself; mine was kind of like a suicide but I snapped out of it, I was seeing things like people coming in the room and things . . . and it’s an experience you’ve got to think about because people don’t understand us. BSU3

For some participants, there was a recognition that mentioning suicidal feelings would mean they were able to access support quicker:

I can understand it, but it’s unfortunate because . . . I think you learn that very quickly that you’re based on what you’ve got to say in order for somebody to see you. CSU10

However, there were also instances in which self-ham and suicidal feelings were dismissed, notably by public sector services.

There was an association between the crisis experience and isolation, with a number of factors affecting this. The first of these was feeling unworthy:

I hear voices sometimes telling me that no one gives a shit and like no one loves me and all this stuff, and I don’t believe them but sometimes it’s hard not to, you know? ASU13

The second was a feeling of being unsafe, and so withdrawal and avoiding people or customary activities created a sense of security:

I’ve learned . . . that I can separate myself from people, especially my siblings and my parents, to cut myself off and give them that space so that they haven’t got a power over me to hurt me or impact me in a way. CSU9

Third, and associated with a sense of shame, was the awareness of MH-related stigma and a perception that they would be judged unfavourably by family, employers and community members:

You know if you suffer from mental health in the Asian community, there’s a stigma attached and they think that ‘she’s gone, she doesn’t know what she’s doing and everything’. BSUFG

Finally, isolation was identified as a consequence of the crisis experience, with a complex interaction between escalating poor MH, social impact, reduced capacity to perform tasks and usual roles, and poor access to services.

• Factors implicated in the experience of a mental health crisis

A wide and complex range of factors were identified as influencing MH and resulting in a crisis, as summarised in Table 10 . The three most commonly mentioned factors were family factors (breakdown, conflict or loss), issues related to MH, and housing.

Factors identified as contributing to a MH crisis

Several participants dated their first experience of a crisis back to childhood, including parental loss and experiences of neglect and/or abuse, with subsequent events retriggering or resonating with this earlier experience. Racism and alienation was also identified as an explanation of the crisis presentation of black African and black Caribbean men and their disproportionate detention under MH legislation:

Racism is a factor, and it is not always blatant or overt. It comes subtly through your surroundings, through the media and so forth. When you’re struggling with feeling marginalised, low self-esteem, meeting racism everywhere you go, it impacts on you subconsciously, or consciously. CVS7

The precarity of individual circumstances was also identified as having a bearing on MH. For example, an asylum seeker was experiencing a MH crisis because of the fear of deportation as a result of their immigration papers having not been sorted by the Home Office, and was subsequently sectioned. Similarly, housing was identified as a critical factor, particularly in site C, which had the highest rate of homelessness. The practice of ‘cuckooing’, where vulnerable people with MH problems are targeted by drug dealers who then take over their homes, was mentioned:

It starts off like friendship and they think oh god this is nice but then they start doing things to keep them under control like demeaning them; I’ve seen . . . where they’ve made them cut their toenails and stuff, to demean them and degrade them and to keep them in it. CVS8

It was evident that, alongside complex social situations, several participants experienced complex difficulties, including experiences of MH problems co-occurring with substance use, a diagnosis of autism spectrum disorder and/or a diagnosis of personality disorder:

I’ve got multiple diagnoses; one of them is psychotic tendencies. I don’t realise when I am in a psychotic episode and I need help. The other thing is I have borderline personality disorder, with that I don’t know when it’s escalating but I do know when I am at the top and really stressed. DCaFG

This could also serve to fuel negative stereotypes, intersecting with other forms of stigma (e.g. related to addiction or learning disabilities) and detract from people having their needs met.

• Impact of the crisis

The impact of the crisis was often profound and, for some, the experience had shaped their lives:

The impact of recovering really from a crisis in a space of a few days has a knock on effect on people’s lives and for me it’s really stolen a lot of my life, you know; I’m 40 now and I’ve just got my mental health on track. ACa3 (friend and service user)

From participants’ responses, it was possible to identify different types of impact, which interacted:

• emotional impacts, undermining self-belief and self-worth
• impacts on social networks and directly on family members and carers (as discussed later in this chapter)
• changes in personal circumstances as a consequence of the MH crisis (e.g. relationship breakdown, unemployment and isolation)
• changes arising from the service response (e.g. the sense of not being understood, being arrested by the police, being detained under the MHA in hospital, medication changes or access to different forms of treatment or therapy) and
• changes in behaviour or perspectives.

These impacts could be negative but could also be positive, particularly when the experience led to an individual reappraising their circumstances or approach to life, on their own or with the support of informal networks or services. This was evident for those service users we re-interviewed who had reflected on the crisis experience and made changes as a consequence. These were sometimes attributed to the VSO response, as discussed in Chapter 6 , but also reflected individual agency.

• Service user needs in a mental health crisis

Reflecting the intensity of the experience and the sense of threat, the most commonly cited need was to feel safe – ‘to be in the safety zone’ or ‘a calm place where you could talk to people’:

You just want to be wrapped up. Safe-guarded if you like; know you’re in a safe place because perhaps you feel threatened. ASUFG

It was evident that safety is relational – ‘building trust and confidence’, ‘being heard’, ‘reassured’, ‘accepted’ and ‘not being judged’:

I was really fed up because it was like a really vicious cycle I couldn’t escape and it was doing my head in, it was dragging me down, and I just wanted to talk to someone who would like help me reason it out and bring me thinking positively again to get me out of that deep, dark place. CSUFG

‘Kindness’, ‘being listened to and not being dismissed’, ‘time and space to make sense of the experience’, ‘being treated with care’, ‘compassion’, ‘understanding’ and ‘humanity’ are how participants described what they needed:

When I’m in crisis or going into crisis I need people to be kind rather than kind of tough love approach, it doesn’t work with me. BSU4

Listening and being able to share openly were important, but some participants also sought guidance – ‘a guru, someone to show me, guide me’:

Sometimes, it’s just being reminded of what I need to do and I know that sounds really silly because I know it and I should be able to do it myself, but when I can’t think because there’s too much going round in my head and I feel like I need to self-harm to be calm enough to be able to then distract myself so it’s safe to stop it going any further, but I feel like – and sometimes that phone call stops the self-harm, does that make any sense? ASU13

It was evident that some people had ongoing, and sometimes highly complex, needs. For example, one man described having had difficulties since childhood following his mother’s death and an abusive relationship with his father. He identified as having learning difficulties and had been a regular user of crack cocaine. Living in a homeless hostel, he had been in three different prisons in the preceding 9 months, the most recent because he hit someone for spitting on him when he was homeless.

Family members’ and carers’ experiences

The definition of a carer is a family member, relative or friend who provides care for someone close to them who has physical and/or mental difficulties. Some participants were also caring for an elderly relative or had child-care responsibilities. Those that cared for someone with a MH problem did not necessarily consider themselves a carer, highlighting the reciprocal nature of caring and other roles as more important:

There’s certain connotations to it [identity as a carer] that I probably don’t really want to identify myself with. Because it’s not like that all the time; that isn’t how I would describe our relationship or what’s going on. Also I’m not infallible and I also have ups and downs or whatever, so sometimes she has to look after me. So it feels a bit kind of one-sided to call me a carer. CCa1 (partner)

It was clear from the carers we interviewed that, in general, they were under strain, with some also experiencing their own MH difficulties. One carer had made a suicide attempt because ‘something tipped them over’, whereas another had self-harmed:

We . . . often get carers not only caring for somebody with a mental health problem, but they have their own mental health problem . . . I think stats say 80% of carers have some impact on their own mental health. DVS4

Many of the carers had been providing support for many years. This included people who had been young carers (children or young adults) of parents or siblings who were suffering from mental distress. A participant’s father commented, ‘he’s witnessed the things from day 1, from 19, ‘cause it affected him. He had a breakdown himself . . . he was crying, when he saw me in bed’. Another participant had been a young carer for her mother and three of her siblings who were diagnosed with bipolar affective disorder, and one with paranoid schizophrenia:

Life has been strung out on managing, supporting to manage crises, but what the issue was that I didn’t really understand mental health, I didn’t understand what a crisis was, the language used in the field, to help me understand what was taking place with my siblings. S2

There were also parents supporting their adult children who worried about the future in the event of their own death and were not confident that the services would care for them. In one situation, grandparents, with two teenage children, were supporting their daughter and were looking after her 4-year-old child while she was an inpatient. Multiple caring roles were not uncommon:

I’m happy to identify myself as a carer, which means as well as having a mum who’s very physically frail and has memory loss, most directly we’ve got three sons in their 20s and the middle one has Aspergers and the youngest, who’s 23, now has quite severe anxiety and depression. ACFG1

All carers expressed a strong sense of responsibility, often associated with continual anxiety about the person they cared for:

Well, fear of her hurting herself, her killing herself, you know, that kind of thing. Fear of dangerous consequences or loss and that’s an understandable fear isn’t it, to have? ACa2 (husband)

In several instances, they or another close friend or family member had intervened to prevent the person from harming or killing themselves:

It would be very frightening . . . ‘OK what do I do with this situation bar trying to wrestle him to the ground and restrain him’, because he would reach a point where sometimes you walk in and he’d be head butting the wall or he’d have taken a Stanley knife to himself and carved all over his stomach. ASU2 (son)

The interventions to prevent a suicide generally involved calling services, usually the police. In other situations, a family member or carer had been contacted because of concern that the person was about to kill themselves. For example, the police contacted a man because they were worried that his father might be about to take his own life by jumping off a bridge. One carer (a mother) had been a victim of assault by her son:

I have another son – I had to get us out. So as soon as I could extricate myself, we ran out of the door and as I shut the door I heard a bang and he’s thrown the knife after us and it was embedded in the front door. Another time he was pushing the knife in here, oh he’s held various implements at me. He’s broken some teeth, my teeth, he got me in a headlock once. ACaFG

Clearly, these experiences had an impact on their relationship with the person for whom they care and, indeed, on wider family members, including children. This was in a context of austerity and the reductions to public services and welfare benefits, which served to increase the stress for some carers or family members:

We’ve seen significant rise in our caseloads of carers from all walks of life having problems with housing and their mental health suffering as a result – attempted suicide, things like that. And people who are agoraphobic, who won’t go out . . . they can’t access the benefits, ‘cause they can’t get down to the job centre. RN2

• Conceptions of a mental health crisis

Stakeholders commented on the difficulty of defining a MH crisis. Nonetheless, there was a broad consensus that a crisis is marked by acute distress, an increasing inability to cope and the need for an immediate response:

This is quite hard to articulate. I would say if someone’s thoughts, feelings, compulsions, are having an immediate effect on their ability to carry on normal life – so at one extreme that could be very suicidal tendencies, at the other one it could be this sort of crippling fear of leaving the house. And somebody needs some help straight away, and it’s not always immediately obvious what the help is that they need and that’s part of the struggle. ACa2 (husband)

For service users and carers, the urgency involved in needing an immediate response should be considered in the social and personal context of their lives, as they often described the crisis experience as a process that unfolds over time.

Crisis as a disruptive process

So it’s really hard to define crisis when it’s over a long term. I think for me it’s whether crisis is just when it’s perceived by the outside world to be a crisis because she’s nearly killed herself. That for me is quite a different definition from what I saw as somebody close to her, who was somebody ebbing towards it and away from it, towards it and away from it. ACa3 (and service user)

Service users typically contextualised the crisis experience in what was happening in their life; relationship problems, historical and current abuse or trauma, racism, debt, and alcohol or substance use were common:

It was a series of minor crises all along the way really, and then coming more and more frequently. So it’s like about how many you’re getting, and how close together they’re all getting really. How many times a week I feel like I feel suicidal, or feel like I need to call the Samaritans. And when there’s no space between those experiences, I guess that’s a crisis. CSU5

For some participants, crisis was described as an everyday occurrence, often reflecting fundamental existential doubts about the value of living, overwhelming impulses to self-harm, recurrent symptoms of voices or a persistent feeling of not being able to cope:

I have them every day. Well I’m a dramatic person, but I have them a lot of the time . . . where I feel sort [whispers] of suicidal or I feel like I hear voices and I just want it to stop. Like yesterday, I wanted it to stop and I was like well if I just kill myself, it didn’t matter. ASU10

This negotiation with the self was common, with the person balancing various factors, including locating it in a spiritual context:

Well in the Quran it says . . . that if something is that severe that it is affecting your health or it’s going to put your health at risk, because we see suicidal as not halal. It’s a bad sin if you commit suicide. But if you feel like you have no other way out, you feel trapped and you feel forced, the only way you can end what’s going on is by ending your life. DSU4

The factors that were considered in such self-negotiations reflected the resources available (including support and experience of previous responses), the potential for life changes, access to the means to kill themselves, and the meaning of suicide, including the anticipated impact of the act. This process of self-negotiation is portrayed in Figures 2 and 3 (produced by a member of our SRG), with how people think about self-harm ( Figure 2 ) contrasted with the lived experience of self-harm ( Figure 3 ).

How people think self-harm works. Reproduced with permission from Rachel Rowan Olive (https://rachelrowanolive.co.uk), February 2019, personal communication.

The experience of self-harm. Reproduced with permission from Rachel Rowan Olive (https://rachelrowanolive.co.uk), February 2019, personal communication.

The distinction between the first experience and subsequent experiences of a MH crisis was identified by both the service user participants and SRG members. This was viewed as shaping sense-making, the capacity to identify triggers and, thus, self-management. By contrast, some service user participants reported that they were relatively unaware of what was happening and observed that it was those close to them who recognised the signs. This included instances in which a family member or friend, recognising the severity of the situation, had intervened to prevent the person from taking their own life.

Voluntary sector organisations’ conceptions of a crisis

A wide range of definitions of a crisis existed between VSOs, reflecting the breadth of their activity. Suicidal ideation and self-harm were most commonly mentioned by survey respondents, as illustrated in Table 11 .

Conceptions of a crisis of VSO survey respondents

This focus was evident in the interviews with VSOs, and provided a richer and multifaceted conception of a crisis to emerge. Those VSOs that identified as providing a specific crisis service (see Chapter 5 ) emphasised the importance of self-definition of the crisis experience (i.e. taking what the person defined as a crisis as the starting point):

In our experience, a crisis means different things to different people. So we have some people that call because they’re suicidal and then we’ve got the other end where somebody’s not able to contain their anxiety. CVS2

This went hand-in-hand with the importance of acceptance and validating experience. A crisis as a disruptive process was often linked to a lack of personal resources to be able to cope, resonating with the service user experience of being overwhelmed, and linked to the idea of social threat and limited psychological strategies or social resources to be able to respond to circumstances. One crisis-specific VSO, for example, assessed how well-supported people were feeling alongside the intensity of distress and the suicidal thoughts reported:

What we find is that, generally speaking, people may come in with extremely high levels of distress as well as extremely high levels of how suicidal they’re feeling and generally quite low levels of how supported they’re feeling. CVS3

A crisis was also described by VSOs in terms of being unwell or a relapse in a person’s MH. As with service user accounts, this was often situated in an individual personal and social context, particularly by those VSOs providing support to people who had experienced a life crisis, for example homeless charities or those supporting survivors of rape or domestic violence, such that the life event as a crisis and the MH crisis were inextricably linked:

Other people that have . . . been through a very traumatic incident, like they’ve been raped, and they need support today to help them through that. They might be worried about being pregnant, about a sexual health issue or they might have HIV, so those people could also be deemed to be in crisis. DVS5

Public sector conceptions of a mental health crisis

Policy-makers, managers and staff also identified the importance of a MH crisis being subjectively defined:

I think one of the absolute crucial things is that you accept the crisis as the patient or the service user defines it. So a crisis is what bothers the service user and/or their relatives to prompt them to actually seek help. CMHP1

The importance of listening to people in a crisis and validating their experience was recognised:

The . . . worst thing you can do when someone feels that they’re in a crisis is to tell them that they’re not, they don’t meet criteria for a crisis service. It just seems like the least validating thing that you could do. We wanted to be really strong on that message, that if someone says they’re in crisis, they need immediate help, and there’s a wide range of what that help might be, but they need something. S5

Although many of the strategic stakeholders (i.e. commissioners and MH staff) expressed the view that a subjective definition was important, those with operational roles commonly interpreted a crisis in terms of a diagnosable illness. They also suggested that adopting a wider definition had implications for the service:

We were looking for a diagnosable mental health problem; you know, mental disorders. That is not what we see come through the door now, you know, and of course a crisis service has to respond to what people believe a crisis is and, you know, what we see come through the door are very much people that need help with social prescribing, with housing, with benefits. DMHP5

Some participants identify situational crises as distinct from people with mental illness and the implications for support – signposting for practical support or needing active support for mental illness. Some VSOs did understand a MH crisis in terms of deteriorating MH, and this was more likely to be those VSOs that considered that they lacked expertise in this area and would, therefore, refer people to more specialist support.

The shifting conception of a MH crisis was sometimes situated in the historical context of a service-focused definition of a crisis as a consequence of the National Service Framework for Mental Health. The evolution of the crisis definition was framed as moving from having ‘two versions of the truth’ (i.e. the official definition and the lived experience of a crisis) to a single version. However, it also reflected that there are different types of MH crises and a wide range of needs:

A quite narrow definition of crisis as a sort of situation in which people are at higher risk of a hospital admission if they’re not provided with some sort of fairly intensive support . . . It’s crucial to also bear in mind that there’s a broader set of crises where people are really distressed and there’s a strong sense that something must be done straight away . . . what we’ve described it, although I think there’d be less clumsy ways of describing it as a sort of subacute crisis. S22

Conceptions of risk were also linked to definitions of crisis, and covered the risk of harm to self and others, the support available and MH history:

Some . . . people when they become more unwell become very risky, either in terms of self-harm or in terms of irritability and risk of hitting out at other people, or in terms of suicidal thoughts. So when people are referred to us, we’re always assessing their risk and whether it’s safe for them to remain at home, either with or without our support. AMHP3

Risk was mentioned by VSOs and was implicit in the conception of a crisis by service users when they described the intensity of suicidal feelings and self-harm. Risk was also used, particularly by carers, to refer to risk-taking and risky behaviour as a form of self-harm, as in ‘drinking to oblivion, drug taking, and risky sex’.

The critical difference between public sector conceptions of a crisis (particularly of NHS managers and staff) and those of service users and VSOs was the conception of crisis as an event requiring an urgent response as opposed to a process:

To me, it’s somebody who is not coping with their feelings, their day-to-day life, and that’s a broad spectrum, that can be from people who are sad and that sadness escalates to despair like that [snaps fingers], to somebody that you can’t sit and reason with them. AMHP5

This conception has shaped service development, including the relationship with VSOs, bringing with it the challenge of establishing when and how public sector services should respond:

So that was a big tension when we started and the debate is not everything that is a crisis needs a mental health input necessarily and so I think that means that mental health organisations get anxious that they’re going to be somehow responsible for making a response to things, which can be like a social crisis, can be all kinds of different things that happen to people . . . In addition I think generally not wanting to over-medicalise distress or social crisis. AMHP2

The conception of a crisis was reflected in how services are configured, for example crisis support as emergency or out-of-hours provision: ‘to interchange it with out-of-hours support almost so, like, on an evening or a weekend, because traditional services are probably seen as nine to five’ (DVS7). The extent to which VSOs shared the conception of a MH crisis as an event requiring an urgent response reflected their objectives and/or the proximity of their relationship to the NHS and what they were being commissioned to provide. However, service users and carers also defined a MH crisis in terms of the need for an urgent response, often linking this to the intensity of suicidal feelings or self-harm.

Crisis as a turning point

The conception of a MH crisis as a turning point was contested by the SRG for overshadowing the negative aspects and impacts of the crisis experience. In the repeat interviews, some service user participants, however, identified that the experience had made them realise that they had to make a life change to maintain their MH. A crisis as a window of opportunity was identified by carers and by MH staff:

I also see crisis as sometimes a good thing because it’s a chance for things to change when problems are very stuck; sometimes a crisis is a helpful way of actually changing things for the better. BCaFG

Changing things for the better included the person leaving a relationship or a job that was causing too much stress. Service users and carers also identified the crisis experience as ‘a ticket’ to getting access to much needed support from services through enabling services to understand the gravity of their situation:

There are so many gaps in mental health services that people say ‘well it seems necessary to have a crisis to get care’; in other words, if you don’t have a crisis nowadays from a carer’s point of view, it sometimes feels very, very difficult to just have your needs taken seriously. ACaFG

Crisis as a missed opportunity was also implicit in the disappointment people felt in the crisis response and the subsequent support failing to enable a person to address their difficulties, develop preventative strategies and address the underlying reasons for the crisis, as explored in Chapter 6 .

The intensity of distress was described by service user participants, and the overwhelming nature of these feelings was associated with needing to be understood and to be treated with compassion and humanity. The narratives identified the experience of a MH crisis as a biographical disruption: an intense and extreme experience that disrupts everyday life and potentially has far-reaching consequences. A corollary of this is that the experience, and the response, cannot be disconnected from the personal and social context of living. This conception contrasts with a narrow definition of a MH crisis as an episode requiring an urgent response, which means that the underlying difficulties may not be addressed. We identified nuanced and important differences in the conceptions of a MH crisis that are enacted through the policy discourse, service configuration and professional behaviour, all of which may influence the contribution of VSOs and their relationship with public sector services. We explore this in more detail in subsequent chapters.

• Cite this Page Newbigging K, Rees J, Ince R, et al. The contribution of the voluntary sector to mental health crisis care: a mixed-methods study. Southampton (UK): NIHR Journals Library; 2020 Jul. (Health Services and Delivery Research, No. 8.29.) Chapter 4, Experiences of a mental health crisis.
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