Mental health crisis care for children and young people aged 5 to 25 years: the CAMH-Crisis evidence synthesis
Authors: Evans Nicola , Edwards Deborah , Carrier Judith , Elliott Mair , Gillen Elizabeth , Hannigan Ben , Lane Rhiannon , Williams Liz 
Published: May 2023

Background
Mental health care for children and young people is a rising concern, with one in six children aged 5–19 years in England having a probable diagnosable mental disorder. Care for children and young people in crisis is known to be delivered by multiple agencies using a range of approaches.

Objectives
The review objectives of this study were to critically appraise, synthesise and present the best-available international evidence related to crisis services for children and young people aged 5–25 years, specifically looking at the organisation of crisis services across education, health, social care and the third sector, and the experiences and perceptions of young people, families and staff, to determine the effectiveness of current models and the goals of crisis intervention.

Methods
All relevant English-language international evidence specifically relating to the provision and receipt of crisis support for children and young people aged 5–25 years, from January 1995 to January 2021, was sought. Comprehensive searches were conducted across 17 databases and supplementary searching was undertaken to identify grey literature. Two team members appraised all the retrieved research reports (except grey literature) using critical appraisal checklists. A separate analysis was conducted for each objective. Confidence in research findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative research approaches.

Findings
One hundred and thirty-eight reports were used to inform this evidence synthesis, including 39 descriptive accounts of the organisation of crisis services (across 36 reports), 42 research studies (across 48 reports) and 54 grey literature documents. The organisation of crisis services has been categorised as follows: triage/assessment only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, the following four themes were identified: (1) barriers to and facilitators of seeking and accessing appropriate support; (2) what children and young people want from crisis services; (3) children’s, young people’s and families’ experiences of crisis services; and (4) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of a crisis service should be to (1) keep children and young people in their home environment as an alternative to admission; (2) assess need and plan; (3) improve children’s and young people’s and/or their families’ engagement with community treatment; (4) link children and young people and/or their families to additional mental health services, as necessary; (5) provide peer support; (6) stabilise and manage the present crisis over the immediate period; and (7) train and/or supervise staff. The key limitation of this review was that much of the literature was drawn from the USA. Owing to the differences between USA and UK in terms of commissioning and delivering services, approaches to crisis care operating in the USA may not be directly applicable to the UK.

Future work
As only three research studies included in this evidence synthesis had been completed in the UK, a clear case exists for the commissioning of new high-quality studies to generate knowledge about the efficacy and acceptability of crisis care approaches operating in the UK. Future empirical research in this area is planned.

Study registration:
This study is registered as PROSPERO CRD42019160134.

Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.