Understanding lived experience of SHIPP.
Research type
Research Study
Full title
Understanding lived experience of a collaborative police and mental health service intervention for people who experience frequent mental health crises: Surrey High Intensity Partnership Programme (SHIPP).
IRAS ID
322822
Contact name
Elizabeth Barley
Contact email
Sponsor organisation
University of Surrey
Duration of Study in the UK
0 years, 5 months, 1 days
Research summary
The study will seek to understand service user experience of a collaborative police and mental health service intervention for people who experience recurrent mental health crises and frequent contact with emergency services.
Semi-structured interviews will be held with service users either remotely (preferred) or face to face with participants, 18 years or older (n= 15-20) who have been involved in the study since it commenced in 2016.
Surrey police shall recruit participants and provide study information. Consent to participate in the study shall be taken by a member of the study team (JR/CW).
Interviews shall be conducted jointly by a peer researcher who has lived experience of mental health crises (but who is independent from SHIPP) and another member of the study team (JR/CW). Interviews will be audio recorded and transcribed verbatim.
Interviews will consist of questions formed through earlier stages of the project (2 workshops with service users to validate the research's value and determine what are the areas are of interest).
Thematic analysis shall be used to analyse that data.Summary of Results
Perceptions of the purpose of the intervention were mixed and appeared to reflect whether individuals had experienced involvement with the scheme as beneficial overall. Participants agreed in principle with the police and mental health services working together to support those experiencing mental health distress, but several received the impression that seeking help in crisis was a waste of others’ time and moreover, for some this led to arrests rather than receiving a compassionate response. This demonstrated a service-level enactment of a classic stigma confronting people diagnosed with borderline or emotionally unstable personality disorder, and commonly also those who are treated as though so diagnosed because of self-harm and suicidality. All participants reported having at some stage been diagnosed with emotionally unstable personality disorder and the narratives described here are further indications of care being withheld under the guise of boundary-setting.
Relatedly, more than one participant disclosed neurodiversity, including autism or autistic spectrum disorders. There is an increasing awareness of previously unrecognised neurodiversity, which appears to be especially prevalent in women (Lockwood Estrin et al., 2021) and can manifest in emotional dysregulation commonly associated with borderline or emotionally unstable personality disorder. May, Pilkington, Younan & Williams (2021) reviewed whether overlapping diagnoses could be implicated in mis-diagnosed personality disorders and reported inconclusive findings, calling for better focussed research. However, it is accepted that autism often causes people to perceive the world literally, therefore threatening criminal justice sanctions for distress could have a devastating impact on an individuals’ sense of self-worth. Indeed, one participant said involvement on the programme had made them feel worthless and others conveyed the sense that they were time-wasting for seeking help when in acute distress. More broadly, communication was repeatedly raised as a significant determinant of participants’ experiences with the intervention. It seems that greater sensitivity is needed around how policy decisions are communicated to those they impact, with consideration given to not leaving interpretations open to further stigmatising people who are already vulnerable and frequently traumatised.
Lastly, this study has indicated receiving a timely and personalised response can facilitate de-escalation from crisis. For those who had a positive perception of the intervention, receiving tailored support in specific aspects of emergency responses helped de-escalation from crisis or avoided further trauma being triggered. Feeling connected and receiving understanding can be crucial in recovery from recurrent suicidality (Warrington, 2024) and this was a significant aspect of the intervention that participants valued. Given the high incidence of prior trauma among those suffering recurrent suicidality and mental health crises, it is vital that when individuals are willing to share details such as triggers, this information is attended to and made available to help avoid responders inadvertently retraumatising people in need of help. Relatedly, several participants raised issues with the content of their plans or described having encountered reticence to amend aspects of the information. Dynamic risk assessment is critical in mental health and especially in relation to suicide prevention, thus information provided to emergency responders must be kept up to date to avert the risk of damaging responses being led by out-of-date information. Where the responsibility for such updates should lie remains a thorny issue relating to information-sharing in multiagency contexts, but it raises the scope for further concerns in relation how emergency calls are triaged through the Right Care Right Person scheme, and whether this permits the level of dynamic risk assessment necessary to avert the escalation of crises leading people to come to further harm.REC name
North West - Greater Manchester South Research Ethics Committee
REC reference
23/NW/0070
Date of REC Opinion
17 Mar 2023
REC opinion
Favourable Opinion