The purpose of this inductive exploratory research study is to discover, describe, and interpret the perspectives of various population groups regarding ED mental health care. Within the context of ongoing disability reform (actively pursued in Australia since the early 1970s), the construction of the National Disability Insurance Scheme (NDIS) was created and called for a “coordinated national approach to improving the delivery of disability services” [24]. The NDIS has been in existence for 8 years with the initial pilot beginning in 2013 [25]. PSD was soon added to the NDIS, with streamlined access for people with a PSD implemented in April 2019 [5,6]. A primary focus of this study will be to understand and clarify the preferred communication pathways between the NDIS, ED, and consumers with a PSD NDIS plan. To inform health policy, this study will discover and interpret the meaning individuals make of their experiences, with an interpretive, mainly qualitative, approach to understanding the life world and meaning-making of participants with lived experience, their carers, NDIS providers, and ED clinicians. To inform the study, a systematic review has been completed by the research team, which has been submitted to a journal and is currently under review, addressing the following research question: What evaluated strategies are used for enhancing clinical outcomes with communication pathways for continuity of care between the emergency department and mental health community support services for people with mental health concerns or who are in suicidal crisis? (see Multimedia Appendix 1 for a description of the search strategy).

This study focuses on the following emerging research questions based on reporting; gaps in the literature; concerns about the use of isolation and restraint; reports of current practices within the ED; along with consultations with people with lived experience, MIND Australia staff, the research team, and others in the sector:

The study is focused on exploring and interpreting (1) the lived experience of those with a PSD NDIS plan along with an analysis of clinical documentation (participant group 1); (2) the experience of NDIS support coordinator/workers working with people who have a PSD NDIS plan and how they interact with the ED, including communication pathways (participant group 2); (3) the national experience of those with a PSD NDIS plan who present at an ED (participant group 3); and (4) the experience of clinicians in the ED working with people who have a PSD NDIS plan, and how they interact with the NDIS, including communication pathways (participant group 4) (see Figure 1).

Data collection will first aim to elicit the lived experience voice of those with a PSD NDIS plan and carers using semistructured one-to-one interviews (participant group 1). In addition, documents (clinician letters, guides, NDIS plans) and other artifacts (eg, electronic messaging) provided to the person requiring care and/or their carer will also be reviewed to evaluate clinician communication [26]. The phenomenological understanding will continue with NDIS support workers and support coordinators, who will also be recruited to participate in focus groups to explore the current understanding and practice of this population group (participant group 2). Finally, the study will collect national data and understanding from those with a PSD NDIS plan and ED clinicians (participant groups 3 and 4) via an online quantitative survey (see Multimedia Appendix 2).

This exploratory study will enable the discovery of paradoxes and contradictions [27] between three population groups with four different research approaches (interviews, analysis of medical correspondence, focus groups, and quantitative surveys) to compare and contrast themes [28]. An interpretive qualitative approach is considered appropriate for the first two population groups to provide data with rich depth. Primarily, lived experience perspectives, including both consumer and carer perspectives will be generated via interviews and NDIS support workers/coordinators (participant group 2) with focus groups. National quantitative online surveys will be offered to those with a PSD NDIS plan and clinicians working in EDs to give them the flexibility to participate in their own time. The different approaches to the research questions will enable triangulation of data via a convergence of sight lines to bring depth to the analysis.

This research will be guided by trauma-informed practice principles [29], as many people living with a mental health diagnosis are likely to have experienced significant trauma at some point in their lives, most often during childhood. This will include seeking to avoid retraumatization of participants by focusing on their knowledge about service improvement rather than requiring them to disclose a narrative history of an unpleasant experience in the ED. Participants will be provided with a safe environment (physical or digital) and will be encouraged to bring a support person if that is something they would like to do. To engender trust, the participants will be empowered to cease the interview at any time and to not disclose anything that will cause them distress [30].

The principles behind the 5th National Mental Health and Suicide Prevention Plan [31] and the South Australian Mental Health Strategic Plan [32] clearly underpin the need for the lived experience voice to drive change. This study will align with that principle and be active in incorporating the voices of those with lived experience (ie, those with a PSD, the advisory group, and carers) alongside the mental health workforce. By engaging with a lived experience advisory group, the research team will incorporate their specific expertise to design the interview and focus group schedules and the survey questions.

Recruitment strategies will be developed in consultation with the advisory group.

Those with lived experience and carers (participant group 1, approximately n=20: lived experience, n=14, carers, n=7; participant group 2, n<20; participant groups 3 and 4, n>50) will be recruited for one-to-one audio-recorded interviews. Potential participants will be given information and opportunity to ask further questions from the research team and will be asked to discuss being involved in the research with their partner, carer, clinician, or friend. Table 1 summarizes the characteristics of each group and the inclusion/exclusion criteria.

Audio recordings from interviews and focus group (participant groups 1 and 2) will be transcribed and thematically analyzed [28] using NVivo software. Themes will be coded and generated by two members of the research team. Quantitative data (participant groups 3 and 4) will be collated and analyzed using SPSS software.

A strength of this study is the inclusion of a lived experienced researcher and a lived experienced carer researcher (PhD candidate) on the research team. The involvement of a lived experience advisory group for interview, focus group, and survey schedule design is another strength of this project. The advisory group will be invited to contribute and be named as authors to the academic papers that will be generated through this research. This will acknowledge their contribution to the design of interview, focus group, and survey questions, and generation of themes from the data. Another strength is that participant groups 1 and 3 are participants with lived experience.

Limitations include that the codesign focuses on authentically shared power but is restricted to the context of a PhD training journey. As this project is a PhD scholarship, true codesign with a lived experience advisory group cannot occur due to the nature of the project and that the PhD candidate is required to demonstrate research skills rather than others doing the work. Nevertheless, aspects of codesign will be included through consultation with a lived experienced advisory group.

The NDIS has been in operation for 8 years. Although PSD was included in the initial architecture of the NDIS [33], many of the fundamental design features of the scheme were developed without reference to the needs of this population [34-37]. This research project will be the first of its kind in the Australian context to provide data from the lived experience voice from those with a PSD NDIS plan from the perspective of presenting to the ED in a crisis. The results of this project will inform ED clinicians and NDIS service providers of clearer needs of this population group, along with guiding pathways for better continuity of care.

This mixed methods study will triangulate the data from interviews among those with lived experience, clinical communications, focus groups with NDIS support workers, and national quantitative surveys among people with a PSD NDIS plan and ED clinicians. This inductive exploratory research study—with an interpretive, qualitative approach—will discover, explore, and describe the lived experience of those with a PSD NDIS plan when presenting to the ED, in retrospect, primarily from the voices of those with lived experience [37].

System encounters, system experiences, and system-wide processes between the hybrid environment of the ED and NDIS services will be explored with the goal of describing this experience and identifying better communication pathways between the various services to enable those with lived experience to have improved voice and influence health policy.