Developing a Best Practice Model for Mental Health Crisis Care: A Community-Engaged Approach
By Saran Davaajargal
As the pandemic unraveled many aspects of everyday life, it brought to the forefront the urgency of many issues. In particular, the importance of mental health and well-being came into sharpened focus as the healthcare system strained to meet the increasing demands for its services. A highlight of Humber’s research projects addressing mental health and well-being is Developing a Best Practice Model for Mental Health Crisis Care: A Community-Engaged Approach. Led by faculty members in the Faculty of Health Sciences & Wellness and Faculty of Social & Community Services at Humber, the research team is collaborating with Middlesex-London Paramedic Service and a community health centre to develop a best practice model for response to mental health crisis care.
This research project highlights and develops practices that appropriately support all members of the community requiring emergency mental health support. In addition to a best practice model, the project aims to co-develop workshops and training for practitioners working in these fields.
The research questions are two-fold:
- Informed by acute care and community-based institutions, what practices and models of care can provide appropriate, high-quality support for individuals in distress in need of emergency mental health support? In particular, what non-medicalized supports may improve comprehensive care in this area?
- What training, resources and skills may be developed to best support practitioners providing care and support for emergency mental health needs?
Inspiration for conducting social innovation research project
When experiencing a mental health crisis, many people rely on emergency services such as 9-1-1 dispatchers, paramedic services, police services and hospital emergency department services. Emergency response to mental health calls has recently gained significantly greater attention recognizing that these interactions may have potentially life and death consequences for those already in distress. Many of these first response services lack sufficient resources and training, which results in few options to offer when providing care.
The focus of this project is to explore the ways in which models of community-based organizations and acute care institutions (e.g., paramedics, police, and emergency department services) can collaboratively inform the most promising practices for emergency mental health response. The project aims to develop practices to support community members in need of emergency mental health assistance, especially people of lower socioeconomic status, Black and Indigenous communities, racialized people, LGBT2SQ+ and immigrant communities. Of particular interest for this project are non-medicalized, non-traditional approaches to mental health support, including peer support and approaches that account for social determinants of health.
Project goals and timeline
The project is composed of three phases, of which phases one and two will occur simultaneously.
Phase 1: Community-based dimension
- Conduct interviews, focus groups, and surveys with participants from community-based institutions
Phase 2: Acute care institution dimension
- Conduct interviews, focus groups, and surveys with participants from acute care institutions, e.g., paramedic, police, emergency department services
- Conduct observation in an emergency department setting, examining the ways in which those with mental health needs are processed through the emergency department
Phase 3: Customizing models of care to meet emergency mental health care needs in the community. This phase brings together findings from the first two phases and engages both community-based and acute care institutions in a collaborative discussion to inform enhanced emergency mental health response. The aim of phase three is to co-develop customized models of care based on the findings and input of partner organizations to inform promising practices in emergency mental health response. Based on the findings from phase one and phase two, the research team in phase three will aim to develop policy recommendations, workshops and training content for relevant professions both pre-entry to practice and for working professionals.
The research team is currently in the data collection phase. The team is connecting with management and frontline workers from the following settings: paramedic services, police services, emergency telecommunications (dispatch), the emergency department, and a range of community-based mental health organizations and related social services supports.
Additionally, the research team is connecting with participants with lived experience of urgent mental health needs. Data collection entails interviews, focus groups, surveys. The research team also plans to conduct some field observation in emergency departments. Geographically, these different organizations are from various regions throughout Ontario.
Research team
The Humber research team is co-led by Polly Ford-Jones as Principal Investigator and Sheryl Thompson and Danielle Pomeroy as Co-Investigators. The research team is collaborating with Dr. Simon Adam, an Assistant Professor in the School of Nursing, Faculty of Health at York University, and Dr. Patrina Duhaney, an Assistant Professor in the Faculty of Social Work at the University of Calgary. Along with the partner organizations, this multi-disciplinary team of researchers brings extensive academic and frontline experience from across care sectors.
Polly Ford-Jones, AEMCA, MA, PhD., is a Professor in Allied Health in the Faculty of Health Sciences & Wellness at Humber College. She is a practicing Primary Care Paramedic in southern Ontario and a qualitative researcher. Her research focuses on issues of health equity, the social determinants of health, and emergency prehospital mental health and psychosocial care.
Sheryl Thompson, H.BSW, MSW, RSW, PhD.(c), is a Professor and Program Coordinator in the Emergency Telecommunications Program in the Faculty of Health Sciences & Wellness at Humber College. Sheryl has a passion for infusing decolonizing practices along with equity, diversity and inclusion into curriculum and teaching. Sheryl is a Registered Social Worker and is the founder and clinical practice leader of a private practice providing services to individuals, groups, families, and communities. Sheryl has taught across programs at Humber, including Social Service Worker, Massage Therapy, Fire Services, and Emergency Telecommunications, a program in which she is also an alumnus.
Danielle Pomeroy, BSW, MSW, RSW, is a Professor in the Police Foundations Program in the Faculty of Social & Community Services at Humber College. She is a Registered Social worker who has spent the past 22 years working within the criminal justice and mental health sectors. Danielle has extensive experience and training in children’s mental health, youth justice, crisis intervention, trauma, restorative justice, mindfulness, and family relationships. In addition to teaching, Danielle has a small private clinical practice.
As the research project moves into year two, we asked the Humber research team about the project’s notable milestones so far. The research team noted:
“We are excited about the momentum of the interviews that we have been conducting and have had more than 30 interview participants to date, with more scheduled. Another highlight was sharing our methods and some preliminary findings at the Paramedicine Across Canada Expo Pre-Conference research day in Saskatoon, SK in September 2022.
We were also recently invited to present on the collaborative and interdisciplinary nature of our project at the McMaster University 19th Annual Innovations in Palliative Care conference in early February. We are pleased to also have a manuscript just about ready for submission. We have had ongoing team meetings, training, and have been pleased to have two additional RAs join our team in this second year. The most encouraging highlight to date has been the strong interest, support, and enthusiasm in the project from community members and stakeholders.”
—The Humber Research Team
When asked about the milestones the team is looking forward to in 2023, the team responded:
“We look forward to continuing data collection which will wrap up over the next several months, diving further into data analysis, collaborative meetings with our team, and partners, and both continuing and beginning development of some of our planned outputs from this work. Our team is looking forward to leading a workshop at the Centre for Social Innovation Workshop in April at the LAMP Community Health Centre.”
—The Humber Research Team
Community partner organizations
The research team is collaborating with Middlesex-London Paramedic Service (MLPS) and a community health centre to develop a best practice model for response to mental health crisis care. The community health centre is a multi-disciplinary, non-profit, community-led organization that delivers health and social services to its surrounding neighbourhood in Toronto. The organization has identified a significant gap in appropriate emergency mental health response for the disenfranchised communities they serve and the life and death consequences that these inadequate services may have. Through the partnership, the community health centre brings a wealth of experience in meeting the needs of local communities and identifying gaps in existing mental health supports.
MLPS is a regional paramedic service serving rural and urban populations in southwestern Ontario that provides 9-1-1 emergency medical response as well as ongoing community paramedicine to meet the needs of their communities. MLPS is a leader in mental health response and has established programs within their paramedic service to address the mental health calls they receive and create multiple options for emergency mental health care through an alternate destination program (optional transport to a crisis centre rather than emergency department), on-scene crisis response teams and interdisciplinary crisis response teams.
Participation of students
The contribution of the student research assistants makes up an integral component of the research project. The students receive supportive mentorship through training in conducting literature reviews, data collection, analysis and developing outputs for knowledge mobilization and involvement in team meetings and project planning. While developing research skills in the field and working in a collaborative, interdisciplinary environment, the students gain meaningful experience and learn from experts across various disciplines. The research assistants currently participating in the project are Petra Meijer, Chiemela Iheanacho, and Maria Rahman.
When asked about the learning highlights of the experience, Petra and Chiemela responded:
“In my role as research assistant, I learned about paramedic research and interdisciplinary collaboration between police, social work and paramedics in emergency situations. As paramedic students, we gain a lot of valuable knowledge about medical conditions and the standards of care for our jobs as paramedics, but we have limited time to understand the non-medicalized aspects of our profession. Being a research assistant helped me develop a deeper understanding of mental health emergency calls and how I can better work together with allied services as a paramedic in the field. Being a research assistant really gave me the opportunity to gain in-depth knowledge on this topic.”
—Petra Meijer
“As a research assistant, I learned how to conduct research project in accordance with Canada’s legal, ethical and professional codes, and I also enhanced my ability to respond to equity, diversity, and cultural sensitivity in diverse populations. The research project has also informed my knowledge on how to develop policies and interventions centering on countering the effects of racism and other forms of discrimination that hamper access to essential services in underserved or marginalized populations.”
— Chiemela Iheanacho
Reflecting on how working as a research assistant influenced their professional development, Petra and Chiemela stated:
“Being part of this research project has for me personally bridged the gap between my previous career as a conservation biology researcher and now as a paramedic. I am able to use my academic skills to contribute to understanding new and innovative approaches to paramedicine and paramedic practice. Although I’m bound by our current standards in my practice as a primary care paramedic, I know that these standards are constantly evolving, and through my role as research assistant for this project, I learned how I can contribute towards better patient care and the evolution of the profession.”
— Petra Meijer
“Working as a research assistant with Dr. Polly and the team has inspired me to expedite my learning on developing discrimination-free interventional approaches and challenged me to expand my understanding in developing actionable recommendations. Hands-on experience in data analytics is crucial in my career projection, and this position has underlined its significance as well as the necessity for more certification in data analytical methodologies.”
— Chiemela Iheanacho
Potential impact
The anticipated impact of the research project is an improvement to emergency mental health responses, including co-developed customized models of care based on research findings and input across sectors and the development of policy recommendations, both for community and acute care sectors. In addition to improved models of care, resulting workshops and training for professionals working in emergency response fields have the potential to improve the quality of care provision and build capacity in the ongoing development of this field. It is anticipated that pilot models of care developed from the project will lead to continued study and adaptation, which has the potential to have a provincial impact and potentially national relevance for model development.
Get to know more about Polly, Sheryl and Danielle
Polly
Favourite book: Stories about people’s lives are my preferred.
Favourite researcher/innovator or research project: The Psychiatrization of Poverty: Rethinking the Mental Health-Poverty Nexus by China Mills
What does social innovation mean to you? Social innovation means investigating and developing new and innovative ways to meet community needs.
Sheryl
Favourite movie: The Color Purple
Favourite researcher/innovator or research project: “he Stanford study conducted on children’s delay of gratification using marshmallows.
What does social innovation mean to you? Social innovation means finding new ways to address the community needs that may be non-traditional and encompasses worldviews that foster new ways of thinking and being. When I think of innovators, I think of people who are open to challenging the status quo to implement solutions that enhance the wellbeing of a community.
Danielle
Favourite book: The Alchemist by Paulo Coelho
Favourite researcher/innovator or research project: Gabor Maté for his work on Addiction and Trauma and Kevin Cameron (North American Centre for Threat Assessment & Trauma Response)
What does social innovation mean to you? Social innovation means implementing ways of knowing, being and doing that are grounded in practices that work, are inclusive and are meaningful to the people most impacted by them. For example, in our research, we know that a lot of current practices are not working in mental health and we need to hear what is working and do more of that as we look to create a better model for mental health crisis care.