Community Navigators: An analysis of a trauma-informed, community-led crisis reduction intervention in a hospital Emergency Department

Background Increasingly, individuals present at hospital Emergency Departments (EDs) in extreme psychological distress and with healthcare services under increasing pressure, EDs may feel like the only place for those in crisis. This paper describes the Community Navigators programme, a community/voluntary sector-led initiative operating seven nights a week in a busy inner-city ED in Belfast, UK. Trauma-informed staff are trained to de-escalate violent and suicidal behaviours, offer practical advice to patients, family/friends, and provide onward referral and follow-up contact with local services. We undertook a descriptive analysis of the needs of individuals presenting in ED, the types of engagement employed by Navigators and the completion rate of onward signposting/referrals to further community/voluntary sector supports including benefits/housing advice, and counselling. Methods Patient demographic information, referral details and patient engagement reports collected between December 2021 and November 2024 in the ED of the Royal Victoria Hospital, Belfast were analysed. Descriptive statistics and thematic analysis were conducted. Results Over the three years, almost 10,000 engagements with the Community Navigators were conducted. ED attendees were likely to be living in the most deprived areas neighbourhoods, presenting with multiple complex needs and high levels of psychological distress including suicide/self-harm or violence/aggression. The Community Navigators are integrated and play a distinct role within the ED team that is accepted and valued by staff and patients alike. Conclusions The Community Navigator service is connecting with some of the most disadvantaged in our communities and make a valuable contribution to the smooth and effective running of a busy ED. By offering practical support and advice, they can provide reassurance and understanding to those needing emergency care and direct the delivery of elements of non-medical support in a resource-stretched environment. Encouraging community-based connections available outside of emergency settings may reduce future ED presentations. Accessible practical support may help individuals and families and by offering access to material help, debt advice, signposting to community mental health, peer support or training and employment opportunities, having someone to talk to could help prepare the foundations for help-seeking and service engagement.