Service users' perspectives on acute, outreach and outpatient psychiatric crisis interventions with and without peer support: results of a qualitative study.

BACKGROUND: Crisis intervention teams assist individuals in acute mental health crises. If unavailable or situations escalate, the police may be involved, and compulsory admissions may be initiated in case of risk to self or others. - measures often perceived as stigmatizing and traumatizing. Respectful, empathetic interactions can prevent escalation and reduce coercion. Peer support, by individuals with lived experience, can enhance recovery, improve quality of life, and reduce coercive measures. In the city of Bremen, the Crisis Intervention Service (CIS) handles emergencies via mobile teams or outpatient consultations. The "PeerIntervent" project integrated trained peer support workers (PSW) into two regional Crisis Intervention Service (CIS) teams. This study examines how individuals with severe mental health conditions experience care during acute, outreach and outpatient psychiatric crises. METHODS: Semi-structured interviews were conducted with 25 individuals recently affected by psychiatric crisis interventions and analysed using qualitative content analysis. RESULTS: CIS was involved in all cases; PSW in six cases, police in eight. Empathic listening, calm communication, transparent explanations, and involvement in decision-making were described as supportive. Confrontational communication or insufficient information was experienced as distressing. Structural factors, including staff continuity and the waiting environment, also shaped overall experiences. Peer support was largely perceived positively, with the sharing of lived experience associated with authenticity and hope. Experiences with police were described ambivalently, ranging from reassuring and supportive to intrusive and escalating. CONCLUSION: Findings highlight the importance of calm, empathic, and transparent communication for trust and perceived safety, supporting the need to strengthen targeted training for all crisis care providers, including police. In line with prior research, PSW may complement crisis care by providing experiential credibility and hope, but their use should remain context-sensitive and requires further study. TRIAL REGISTRATION: The study was approved by the Ethics Committee of the University of Bremen on June 20, 2022 (reference: 2022-09) and was registered in the German Clinical Trials Register (DRKS) on July 4, 2022 (DRKS00029377).