A Speculative Design Study to Reimagine Crisis Care

Background Compulsory inpatient care within the UK is subject to numerous critiques, relating to lack of safety and over-representation of people from the Global Majority. Numerous studies have understandably focused on service user experience, but few have looked at service users’ recommendations for change. Since the establishment of the first recorded asylum in 1403, there have been numerous challenges and evolutions in crisis care, notably through the anti-psychiatry movement, the early psychiatric survivor movement and deinstitutionalisation. Current alternatives to inpatient care include crisis houses, Open Dialogue and the Soteria Network. Current research and policy rarely focus on recommendations outside of the arena of mental health, despite acknowledgements that many of the root causes are socio-political. Inspired by bell hook’s love ethic, and utilising tenants from speculative design, this research seeks to explore how inpatient care can be reimagined, if human flourishing was the principle organising factor. Methodology This study has used a speculative design methodology, underpinned by a standpoint epistemology; with 13 participants taking part in three focus groups each. The participants were divided into two groups, seven in a staff group, and six in a service user group. Findings Reflexive Thematic Analysis was used to analyse the results, resulting in four themes; ‘Conceptualising Crisis Care,’ ‘Glimmers of Imagination,’ ‘Barriers to Imagination and Change’ and ‘Societal Transformation.’ Participants described their understandings of crisis, exploring the societal narratives around madness and how these influenced crisis care. They spoke to the power of imagination, and explored imaginative alternatives to care currently. However, participants also noted many barriers to the process of imagination and discussed the impact of institutional cultures, dominant financial discourses, power, the challenges of reimagining something that already exists, all resulting in a sense of stuckness and fatigue. Participants explored what could happen to move beyond this point highlighting the need for societal shifts in our understanding of madness, facilitated by meaningful connection with others. Conclusion The research points to the impact of bureaucratic systems on the ability to provide care, the machinations of disciplinary power and the challenges with recreating pre-existing systems. It highlights the need to focus upon and develop working utopias in response to harmful systems, alongside facilitating ways in which mad wisdoms can be shared and upheld.