Perceptions of Initial Response to Mental Health Crisis Situations : A Study among Nurses

Purpose: This study aimed to explore the subjective perception types of nurses regarding initial response to mental health crisis situations using Q methodology, and to provide foundational data for developing mental health crisis initial response education programs for nurses. Methods: This exploratory study applied Q methodology. From the Q population constructed through literature review and in-depth interviews, 32 Q samples were selected after expert validity verification. Q sorting was conducted with 40 nurses who had experience caring for patients in mental health crisis situations at general hospitals, tertiary hospitals, and community settings. Principal component analysis with Varimax rotation was performed using the KADE program. Results: Nurses' perceptions of initial response to mental health crisis situations were classified into three types with a total explanatory variance of 56%. Type 1(Response Anxiety and Professional Dependency Type, n=16, 40.0%) experienced high anxiety in mental health crisis response situations and perceived related conversations and interventions as the domain of mental health professionals. Type 2(Emotional Competence with Intervention Burden Awareness Type, n=15, 37.5%) possessed emotional competence to approach individuals in crisis empathetically but hesitated to provide initial response due to concerns about ongoing involvement after intervention. Type 3(Initial Response Competence and Education Necessity Recognition Type, n=9, 22.5%) demonstrated competence and confidence in mental health crisis response and recognized the necessity of nurses' roles as first responders and the importance of education dissemination. Conclusion: Nurses' perceptions of initial response to mental health crisis situations exhibited multidimensional structures with qualitatively distinct characteristics, and response patterns varied by type. For effective enhancement of mental health crisis initial response competence, tailored approaches by perception type are necessary. For Type 1, messages emphasizing “you can be a first responder” with evidence-based education; for Type 2, clear conceptual education on the scope of initial response roles and role termination after professional referral; and for Type 3, assignment of clinical educator and peer mentor roles are recommended.