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Abstract

Objective:

Expanded funding to support care across the crisis continuum is intended to improve behavioral health outcomes. A greater understanding of how to effectively implement and integrate local crisis care systems has been identified as a research and policy priority. The aim of this study was to explore provider perceptions of the barriers and facilitators associated with implementing effective behavioral health crisis services.

Methods:

The authors conducted semistructured qualitative interviews with personnel from 15 behavioral health crisis care programs across California. Purposive sampling was used to ensure adequate representation of peer specialists, clinicians, mental health workers, and program leaders. Interview transcripts were analyzed via an inductive approach to thematic analysis. On the basis of patterns identified in the data, initial codes were developed, reviewed, and combined into overarching preliminary themes and subthemes.

Results:

Twenty-nine crisis care personnel participated. Facilitators of effective crisis care included an optimal crisis service structure, a client-centered approach, engagement with clients’ support systems, and collaboration with community partners to link clients to services and enable safe delivery of crisis care. Barriers at the client, program, and system levels were identified, with solutions proposed for each.

Conclusions:

The participants identified features of crisis care that could improve program implementation and effectiveness or could help mitigate identified barriers. As states and local municipalities work to implement an integrated system of care across the crisis care continuum, input from frontline providers can be used to support the development of new programs, refine existing services, and inform future directions for research.

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Information & Authors

Information

Published In

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Psychiatric Services

History

Received: 20 June 2024
Revision received: 12 August 2024
Accepted: 11 September 2024
Published online: 12 November 2024

Keywords

  1. qualitative interviews
  2. implementation science
  3. crisis continuum
  4. mental health crisis care
  5. barriers and facilitators
  6. quality of care

Authors

Details

Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Regina Gemignani, Ph.D.
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Jamie Mouzoon, M.A.
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Bethney Bonilla-Herrera, M.A. https://orcid.org/0009-0005-0650-3682
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Matthew L. Goldman, M.D., M.S. https://orcid.org/0000-0002-2252-9285
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Joy Melnikow, M.D., M.P.H. https://orcid.org/0000-0002-9963-6089
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).
Cameron S. Carter, M.D.
Department of Psychiatry and Behavioral Sciences (Savill, Banks, Gemignani), Behavioral Health Center of Excellence (Mouzoon), Center for Healthcare Policy and Research (Bonilla), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman); Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine (Carter).

Notes

Send correspondence to Dr. Savill ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

This research was funded by the California Mental Health Services Oversight and Accountability Commission (17-MHSOAC-073).The views in this article represent the opinions of the authors and not necessarily those of the California Mental Health Services Oversight and Accountability Commission.

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