Ways of contact and reasons for contact
The fact that telephone contact and physical presence was equally common, may express that flexibility with respect to type of contact is important for accessibility. About half of the patients took contact on their own initiative. Referral of every 4th patient by Bergen Accident and Emergency Department may indicate that the Crisis Support Team cover a need for conversation that is not offered by the out-of-hours services. Some patients who came to a GP within the out-of-hours service would probably have been without an offer if the Crisis Support Team had not existed, while others would have been referred to their regular GP or their own network.
A majority of patients came to discuss life crises that Team members did not classify as mental disorders. The life crisis term used here includes both acute events and more long-lasting stress situations within close relationships. If the patient does not get enough support, unexpected occurrences and communication problems within families may, however, be risk factors for developing mental disorders. Patient descriptions of ailments will overlap between categories because crisis reactions and symptoms of anxiety and depression may have a common content. Occurrence of acute events, duration of symptoms, depth and extent of problems will normally separate normal crisis reactions from mental disorders (2,3). In this study, worries about others and communication problems in the family were classified as a life crises. Such problems may be an expression for one in a family having a serious symptom of a mental disorder or a substance abuse problem without getting sufficient treatment. Symptoms of mental disorders may start in new stressing life situations as for example a relational problem, moving, change of job or start of studies (3). The Crisis Support Team’s personnel are meant to have competence in basic diagnostic categories.
Through guidance and conversations aimed at defining problems, the Personal Crisis Support Team may provide important support to parents who worry about children. The Team is more accessible and spends more time on conversations than a GP can offer and it may be easier to bring children, and others one worries about, to a Crisis Support Team than to a doctor. In addition psychosocial crises is an area where several professional groups have valuable competence. Depression and suicide problems are conditions that require assessments by a doctor. In these cases a conversation with the Team is not sufficient, but the personnel may contribute to bringing patients with undiagnosed or untreated mental disorder to a doctor for assessment of treatment needs.
Break-up of partnerships was the most frequent serious life crisis among those who took contact. Municipal crisis teams were not used for break-up of personal relationships. However, it is our experience that more people contact their regular GP, out-of-hours doctor and own network in crises concerning partners. The Norwegian Knowledge Centre for the Health Services have summarised effective measures in psychosocial crises (5); in this summary they have left out life crises such as break-up of partnerships and limited the study to single events such as suicide, fire, accident and violence. Nevertheless, experience and research shows that break-up of partnerships may affect people very hard (8). In some descriptions of a mental crisis, break-up of partnerships and infidelity are unexpectedly included, and this is related to the feeling of loss (9).