Communities of Practice in Emergency Mental Health Care for Involuntary Patients in Common Law Countries: A Scoping Review of Evidence Gaps

Abstract

Background Emergency departments (EDs) play a critical role in managing individuals experiencing mental health crises who are involuntarily transported under mental health legislation. Although collaborative models such as co-responder teams and diversion services have shown operational benefits, their implementation is inconsistent and rarely embedded within systems that support sustained practice development. Communities of Practice (CoPs), which emphasise ongoing social learning and shared practice, may offer a framework to address this gap. Objective To map the scope of published research on involuntary mental health presentations to EDs and to assess whether the evidence supports the existence, implementation, or potential value of CoP approaches in this context. Eligibility Criteria and Information Sources Peer-reviewed studies published in English from 2008 onwards were included if they examined responses to involuntary mental health presentations in EDs within common law countries (Australia, Canada, Aotearoa New Zealand, the United Kingdom, and the United States). Searches were conducted in Medline, PubMed, Embase, PsycINFO, and Google Scholar, supplemented by targeted grey literature searches and an AI-assisted search tool. Methods Following Joanna Briggs Institute scoping review methodology, studies were screened and selected by two independent reviewers. Data extraction and synthesis were conducted using a structured framework, with studies analysed for evidence of CoP-consistent elements such as collaborative learning, interagency communication, and shared practice development. Results Sixty-five studies met inclusion criteria (40 quantitative retrospective, 11 quantitative prospective, 10 qualitative, and 4 mixed methods), predominantly from the United States (n=30) and Australia (n=23). Only one study explicitly evaluated a CoP, and no sustained CoP structures were identified. While many studies described collaborative practices consistent with CoP principles-such as interagency coordination, shared training, and improved communication-these were typically operational and episodic rather than embedded in ongoing systems of shared learning and practice development. Conclusion Despite the growth of research and the demonstrated benefits of collaborative service models, there is little evidence of formalised CoP approaches in emergency mental health care for involuntary patients. This absence suggests a gap in sustained collaborative learning mechanisms that may limit system level improvement. CoPs may offer a theoretically coherent framework to address this gap. Future research should examine the feasibility, implementation, and impact of CoPs, particularly through qualitative and mixed-methods approaches.