Abstract

Despite decades of policy promises, the shortcomings of mental health crisis care in the UK are well-documented. As well as gaps in service provision (Centre for Mental Health, 2025; Trevillion, et al. 2022), the literature consistently highlights reports of clinical detachment and an overreliance upon those bureaucratic tasks aimed at monitoring risk (Averill, et al. 2024) which are often experienced by service users as being invalidating rather than containing. Specifically, for those with Complex Emotional Needs (CEN), structural inequalities, manifesting as a lack of relational care are also highlighted (Trevillion, et al. 2022), often being ascribed both to therapeutic pessimism, and to stigmatising attitudes (Foye, et al. 2022).

Arguably, however, pinning these failures of mental health crisis care solely upon those who deliver it oversimplifies this issue - overlooking both the emotional toll of working within hostile neoliberal healthcare systems and the nuances of complex, bi-directional anxieties arising at the clinical frontline. While Warrender (2024) has certainly come close in his description of confused and anxious crisis systems (citing the lack of clear models of intervention and systemic risks linked to the fear of litigation as key contributors), I contend that a further shift is needed to consider how macro-systemic anxieties are operationalised at a micro level. Understanding these issues - and indeed, how to resolve them - requires us therefore to re-focus upon those reciprocal relationships which define the crisis encounter itself.