Shetland Lifeline

1. Introduction

The proposal to create a crisis response service in Shetland was inspired and shaped by service users of Shetland Link Up, a drop-in centre for adults experiencing or recovering from mental distress. In January 2006, we started to consult service users known to us about their experiences of being in crisis in Shetland and their admissions to and treatment in the Royal Cornhill Psychiatric Hospital, Aberdeen. We found respondents in general to be deeply dissatisfied with the way they had been treated, and so organised a workshop for service users only (8th February 2006) for them to express their views about the help they would like to receive when in crisis.

The proposal that resulted took full account of the views expressed to us. We believe that the design of a crisis service must be user-led, and that care must be taken to ensure that the original vision of the project is not lost as the practical details are worked out. The initial proposals were modified through discussions later in 2006 with a number of interested parties and further amended during the process of making (unsuccessful) applications for funding. At each stage, a consultative group of Link Up service users was convened, and the changes approved.

Since the service became ‘live’ on October 1st 2008, a number of operational adjustments have had to be made as we have learned what is possible (in terms of staffing and administration), and what most helpful in terms of service delivery. We will continue to develop the project in the light of experience.

2. What is a crisis?

2.1 The principal text we have used in preparing for crisis counselling is Crisis and Trauma, Developmental-Ecological Intervention by BG and TM Collins Lahaska Press, 2005.
On page 4 they offer two basic definitions of crisis:

Slaikeu (1990,p15) defined crisis as "a temporary state of upset and disorganization, characterised chiefly by an individual's inability to cope with a particular situation using customary methods of problem-solving, and by the potential for a radically positive or negative outcome."

James and Gilliland (2001) defined crisis as "a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person's current resources and coping mechanisms."

2.2 The National Standards for Crisis Services (November 2006), top of page 4, speaks of "periods of acute illness, relapse or mental distress". The problem with this as a definition is that (apart from the part about 'mental distress') it is already an interpretation and medicalisation.

We feel that the basic definition of 'crisis' should be in terms of the person's experience of acute mental distress and their inability to cope with their current situation with their usual strategies. The interpretations - precipitating factors, dimensions, risks, consequences and ways to resolve the crisis - are what emerge when it is assessed.

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