Evaluating the effectiveness of crisis support spaces in Queensland, Australia: a mixed-methods study

Safe Spaces offer a person-centred, non-clinical and welcoming place for adults experiencing a mental health crisis to seek support as an alternative to presenting to the Emergency Department (ED). The aim of the study was to evaluate the effectiveness of Queensland Health’s Crisis Support Spaces (CSS), which are a hospital-based Safe Space service that has been piloted in the state of Queensland in Australia. The research employed a mixed-methods design. Retrospective, de-identified program data was analysed from 2,235 consumers who accessed a CSS in Queensland during the period of 23/01/2021 to 31/10/2023. Outcome variables were computed using data from Queensland Health’s Consumer Integrated Mental Health and Addiction (CIMHA) and Emergency Data Collection (EDC) datasets. Within-groups t-tests were used to analyse pre- to post- intervention changes in psychological distress ratings, number of mental health related ED presentations and number of mental health related hospital admissions. In addition, 78 semi-structured interviews were undertaken with CSS consumers and carers, CSS staff and broader mental health system staff; these were analysed using applied thematic analysis. Consumers experienced a statistically significant, large sized reduction in psychological distress ratings at post-intervention (mean difference = -2.9; p <.001; d = 1.30). A statistically significant, large sized reduction was also observed in the number of mental health related hospital interventions at 6-months post-intervention for those consumers with a prior history of inpatient admissions (mean difference = -1.0; p <.001; d = 0.80). Furthermore, a statistically significant, small sized reduction was observed in mental health related emergency department (ED) presentations at 6-months post- intervention for those consumers with a prior history of ED presentations (mean difference = -0.8; p <.001; d = 0.37). Qualitative data provided insights into potential mechanisms through which the service may achieve its intended outcomes (e.g., providing a safe environment for consumers to de-escalate their psychological distress, teaching consumers skills to self-manage their mental health). The findings of this study provide mixed-methods evidence supportive of the effectiveness of CSS in helping consumers reduce their psychological distress and preventing mental health related ED presentations and hospital admissions.