Crisis Intervention in Mental Health

Anything can and probably will happen eventually. Health care professionals need to be prepared at all times to effectively respond to and manage a crisis. The people you care for may have a number of mental health crises and emergencies. These crises may be associated with various mood disorders, anxiety or anger, substance use, and major mental illnesses like schizophrenia, bipolar depression, and dementia with aggressive and combative behaviors.

Defining a Crisis

What exactly is a crisis? It can be characterized as an acute, time-limited event that is experienced as an overwhelming emotional reaction to an individual’s perception of that event. Anyone at any time can experience a crisis, especially in mental health, senior living and other residential settings. The crisis may or may not be associated with any mental disorder. Instead, the crisis may identify that something is out of balance in the individual’s life. The crisis occurs before the individual can restore that much needed balance in his or her life.

If you’re reading this article, you probably have been involved in a crisis situation and work in various settings like nursing homes, assisted living communities, home health, hospice, hospitals, clinics, ERs, or perhaps you work on a crisis hotline.

Law enforcement defines a crisis a little bit differently. In the eyes of the law, a crisis means that stressors are increasing, and probably significantly, and the individual’s coping skills are decreasing. When you mix these two factors together, legally, we have a possibility of a crisis. The individual then becomes dangerous to one’s self and others, and becomes unable to effectively function.

Communication and De-Escalation: The First 2 Steps in Crisis Intervention

Communication and de-escalation are the very first steps to take when you are working with individuals you feel may be experience some kind of crisis. They are the go-to interventions and are to be used when a person is suspected of having behavioral or mental health problems, severe mental illness-related issues, developmental or intellectual difficulties or extreme emotional stress or distress.

People who are actively experiencing an immediate crisis will usually display the following:

1. Failed coping methods
2. Inability to function
3. Has become a danger to self and/or others

Communication and de-escalation are important to use because they set some conditions in which the crisis situation can be defused, calmed or contained.

Goals of Communication and De-Escalation

Although there are many goals to communication and de-escalation during a crisis, the most common goals would be to build trust with the individual experiencing the crisis. Another is to be non-threatening and avoid triggering any further emotional response. One always wants to calm a tense situation peacefully and non-violently. No one wants the need to use physical force unless it is absolutely necessary. Another goal to think about is decreasing the stigma of behavioral and mental health issues so that people don’t go into a situation with pre-existing stereotypical thoughts and biases. The ultimate goal, of course, is to safely resolve the crisis.

Final Thoughts

No one began their health care career thinking that one day they would be in the middle of an active shooter event, a major psychiatric crisis or some other act of violence. Health care settings can become a place where crises like these take place. Today’s health care professional should be well trained in threat assessment, crisis intervention, de-escalation, and active shooter survival. This article began by stating that anything can and probably will happen sometime during your career. It is best to be smart and prepared. A wise law enforcement officer once told me “Hope is not a plan”.

More About Behavioral and Mental Health

• Mental Illness and Aging: A Quick Look
• Behavior Management: The Person-Centered Way