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

Descriptive studies on the experiences of service users in psychiatric emergency wards are increasing. However, the experience of users throughout the whole psychiatric emergency procedure, the ‘patient journey’ from the moment of mental health crisis leading to admission in a psychiatric inpatient unit, has rarely been studied. This article aims to make a further contribution to this body of knowledge by not only describing the service-users’ journey but also shows whether and how that perspective is received by other stakeholders like healthcare professionals, family-members, police, representatives of the municipality and ambulance staff and representatives of the municipality, to jointly make action-plans for improvement. A responsive evaluation including interviews, focus groups and dialogue session with a transformative aim was conducted in a mixed team of researchers with and without experiential knowledge. Service users and other stakeholders agree on the main issues: the importance of contact; signaling; expropriation and earning freedom. However, proposed actions 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. We conclude that responsive evaluation can help to create a more informed and kaleidoscopic view of the complexity of psychiatric emergency care. Therefore, we recommend that various actions need to be considered to meet the needs of service users better covering all phases of Tronto’s care ethical model: caring about, taking care, caring giving and care receiving