Optimal Care Pathways for People in Suicidal Crisis Who Interact with First Responders: A Scoping Review

Background: First responders play a vital role in attending to people in suicidal crisis and influencing their care. Aims: To examine existing care pathways and models of care that could be used for people in a suicidal crisis who have come to the attention of first responders. Methods: A scoping review of academic and grey literature published between 2009 and 2019 was conducted, supplemented by consultation with experts, service providers and people with lived experience. Results: The search identified 703 studies. Twenty-three peer reviewed and grey literature articles, as well as one personal communication, were considered eligible for inclusion. Six models, covering 22 programs, were identified. No studies were identified that described care pathways, per se. Co-responder and safe haven models were associated with reduced hospital use and police detentions. Aftercare models were associated with improved well-being and reduction in symptoms. Co-responder, safe haven, and aftercare models were all rated positively by service users. No studies measured the impact on longer term suicidality. Limitations: Inclusion criteria were broad resulting in heterogeneity of studies and designs, limiting comparisons. Few studies employed standardised measurement protocols, reducing the ability to draw sound conclusions. Conclusion: Several novel programs have the potential to support individuals in crisis who encounter first responders.