Davies, Kerry
(2016)
What is a crisis?: service user, carer and professional understandings of crisis: a Q-methodological approach.
DClinPsy thesis, University of Nottingham.
Abstract
Background. This topic was proposed by the Service User and Carer Advisory Panel (SUCAP) which informs and supports Clinical Psychology training at The University of Nottingham. The project developed due to their concern about the ambiguity of crisis. They suggested that their understandings may be different from that of professionals. The reconfiguration of acute mental health services influenced the nationwide implementation of community treatment alternatives. However, crisis has remained a poorly operationalised concept, which can lead to problems in clinical practice. An increase in empirical efforts has aimed to establish clarity and increase the clinical utility of definitions. Despite these efforts, little is known about how service users and carers understand crisis. As suggested by the SUCAP, it is unclear if there is commonality within understandings of crisis. Due to the multiple stakeholders, exploring understandings of crisis from multiple perspectives could be useful in clinical practice.
Aim. This study aimed to use Q-methodology to investigate multiple perspectives of crisis. By including service users, carers and professionals the research aimed to highlight consensus and discrepancy within these perspectives.
Method. Twenty-six participants were recruited from a National Health Service crisis team, a third sector crisis service and an independent carer support group. In Phase One, clinical interviews with 16 participants (taken from each group) were conducted. Qualitative analysis aided the process of constructing a Q-set of 78 statements that represented the understandings of a crisis experience. In Phase Two, 13 participants (some of whom took part in Phases One and Two) completed the Q-sort procedure, in which they rated the extent to which each statement was characteristic of crisis. To support analysis and interpretation, demographic information was obtained, and pre/post questions elicited reflection on their completed Q-sorts. An inverted factor analytic method was used to analyse the Q-sort data.
Results. The results of each Phase are discussed. The rotated two factor solution accounted for fifty percent of variance in people’s understandings of crisis. Factor one related to the understanding of crisis as an experience which can be defined by changes in awareness and perception of reality. Factor two related to the understanding of crisis as intense emotional pain, which is largely related to fear, anxiety and despair. Contrary to existing definitions of crisis, risk and mental illness were not highlighted as central characteristics of crisis. Different pairs of ‘groups’ (service user/professional; carer/professional; service user/carer) had little impact on the amount of shared understanding. However, understandings of crisis were highly variable between individuals. Furthermore, service users’ understandings were more variable than those of professionals or carers.
Discussion. Although the findings offer some support to current theories of crisis, they contrast with the dominating characteristics of crisis represented in policy and empirical literature. This suggests that over deterministic definitions of crisis, that focus on risk and mental illness, are insufficient. These findings have implications for both clinical practice and future research.
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