Pathways for Improvement of Care in Psychiatric Crisis: A Plea for the Co-Creation with Service Users and Ethics of Care

Abstract

The number of descriptive studies on the experiences of service users in psychiatric emergency wards is increasing. However, the experiences of users throughout the whole psychiatric emergency procedure, the “patient journey” from the moment of mental health crisis to admission to a psychiatric inpatient unit, have rarely been studied. Furthermore, there is little research on perceived solutions for improvement of the “patient journey” from different perspectives (those of service users and other stakeholders such as health care professionals, family members, police, representatives of the municipality, and ambulance staff). A responsive evaluation including interviews, focus groups and a dialogue session with a transformative aim was conducted in a mixed team of researchers with and without experiential knowledge. Service users and other stakeholders agreed on two main issues that needed to be improved: making contact with service users on the “patient journey”, and better signaling of a crisis. The third main issue about more focus on recovery in the emergency ward was contested, as some stakeholders prioritized safety. Proposed actions for improvement of these issues differed between users and professionals. Service users proposed relational actions to offer good care. Professionals recommended actions in response to issues of fragmentation and discontinuity in the organization of care. We conclude that co-creation with service users in improvement is necessary to address their needs and tackle the complexity of psychiatric emergency care. Therefore, by utilizing Tronto’s ethics of care model, we recommend that various actions need to be considered to meet the needs of service users.