Crisis 101

Written by Cassie Loller

In the world of behavioral health, crisis is not very new to us. From crisis lines saved on our phones to crisis plans we create with our clients; we all know the term. As a child and family therapist who primarily works with adolescents and young adults, helping my clients and families through mental health crisis’ is something I have grown to be familiar with. However, even though the experience is there, getting that crisis call or having that crisis session can still feel very intimidating and overwhelming.

Below are some of the things I like to remind myself of when it comes to working with clients in crisis, as well as my role in crisis intervention.

What is considered a crisis?

A formal definition for a mental health crisis is  “any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community” (National Alliance on Mental Illness). Now I know what you are probably thinking “Dang Cassie, that can mean anything” and you would be right. Mental health crisis’ are going to look, sound and feel different for every single person. Sometimes mental health crisis’ are loud and in your face. And other times they are more internalized, hidden, and slight.

What is important when considering what a mental health crisis is, we need to look at what does the individual consider to be a crisis for them. Everyone has their different thresholds. What may seem small and simple for one, can be considered a point of crisis for another. It is important that we don’t judge or demean the personal experience for a person in crisis.

What can contribute to experiencing a crisis?

Listed are some factors that can contribute to an individual experiencing a mental health crisis (Mind 2020):

• Bullying and poor relationships
• Difficulty obtaining/meeting “basic needs”
• Experiencing discrimination, prejudice or stigma
• Financial hardships
• High levels of stress or experiencing stress long term
• Lack of support system and community connection
• Overall feelings of loss (death, end of a relationships, loss of something significant, etc.)
• Physical Illness or Injury
• Social Isolation and Loneliness
• Substance use and misuse
• Traumatic experiences
• And many more…

Knowing and understanding the contributing factors to crisis can 1. help us prevent potential crisis in our communities, and 2. help us intervene when crisis is present. This takes us back to the age-old trauma informed perspective “what is happening to you?” – giving us the opportunity to empathize, understand and accept where someone is coming from and how it is impacting their life and functioning.

What are some “warning signs” that a crisis event may be coming?

“Warning signs” refers to behaviors, emotions, and changes that can hint to a potential mental health crisis. Again, “warning signs” are going to differ based on the individual, their lifestyles, and their unique characteristics. However, they remain important to know and be aware of in order to hopefully prevent, intervene early or before a crisis becomes fatal.

Some of the most common “warning signs” fall into the following categories (National Alliance on Mental Illness):

• Social Withdrawal and/or Changes in Social Relationships
• Change in Interest and Motivation
• Mood Disturbance
• Changes in Sleep Patterns and Sleep Disturbances
• Thought Disturbances
• Irregular Expression of Feelings
• Unhealthy Coping Mechanisms
• Changes in Behaviors
• Thinking and/or Talking about Suicide, Homicide, Self-Harm, etc.

Observing “warning signs” is not always possible or available to us as mental health professionals. Most of us have limited time with the clients and families we serve. However, “warning signs” is also something we can educate our client, families and even non behavioral health staff about in order to increase the possibility of effective prevention and intervention.

How can I help someone experiencing a crisis event?

At this point, you are probably 1. very tired of reading about such a sad/scary/less than uplifting topic, or 2. preparing for someone you know to go into a mental health crisis because of the current state of the world.  Well let’s talk about some important things to remember and do if you ever find yourself intervening during a mental health crisis.

REMEMBER:

• Crisis means something different for everyone.
  • When someone is in crisis, you are not there to judge what they are going through, what they are feeling, or how they are responding to it. Everyone is unique meaning their crisis experience will be unique. Judgement will not get you anywhere close to de-escalating the crisis and may even increase the risk factors.
• You don’t have to “fix it”.
  • Now this is always a hard one for me. Many of us in the helping field feel the urge to problem solve or “fix it”. During a crisis, that is not your role. Crisis often means the emotional brain has taken over and the logical brain is shut down – meaning problem solving for the individual in crisis is not readily available. Your primary role in crisis intervention is to help the individual gain control of their emotional brain for, de-escalate the situation, increase safety, and in turn help them gain access to their logical brain. Coming in to “fix it” rarely does that.
• The crisis will take as long as it takes.
  • This is an important one. Along with not judging someone’s crisis experience, it’s also important we don’t rush it. Crisis will take as long as it takes, and you may have to adjust your schedule to allow for the process to happen. Rushing through a crisis is often for our benefit, not the individual who is experiencing the crisis. As many of our very smart and talented supervisors say, “trust the process”.

DO:

• Empathy and validation go a long way.
  • Many of us know through personal experience, that during emotional or stressful times we really just want someone to listen to us and hear us. The same can be said for the majority of individuals experiencing a mental health crisis. Giving someone the opportunity to express themselves openly, listen to them, empathize with them, and validate what they are saying are not only comforting, but also extremely effective de-escalation techniques. If you ever find yourself in crisis intervention, always go back to the basics of being human – empathy and validation.
• Prep work can help.
  • If you have the gift of knowing your clients before a mental health crisis, doing the prep work can help drastically. Mental health crisis’ are not always predictable, but you can always work on preparing clients and families for the “just in case”. Develop realistic and INDIVIDUALIZED crisis and safety plans. Educate clients and families. Give them the resources for help outside of services. And do not make it a taboo topic to discuss.
• Resources!
  • Speaking of resources… make sure you know them! Diversify your resource list so that way you and the individual that may experience the crisis has options. This also helps with setting boundaries. You are not always going to be available to intervene in a crisis, so make sure there are options besides you. (Pro tip: put the resources in an easy to access area, mine being my phone.)
• Don’t be afraid to follow up.
  • This is one of my favorites. After the crisis event has (hopefully) calmed down and you are back to your normally scheduled services, don’t be afraid to follow up with the client and family. Talk about it, reduce the stigma, learn from that experience, and work to help prevent another one. Sometimes both mental health professionals and clients avoid talking about a crisis. Although it may be difficult, it is an important process in recovery and healing.
• Get to know their history.
  • As discussed earlier, knowing an individuals or family’s history can play a functional and important role in prevention, intervention, and resolution of a crisis event. If you can, get to know what the current stressors are in their lives, their mental health history, their coping mechanisms, and their support network and access to resources.
• If you are doubting their safety, don’t be afraid to refer for further evaluation.
  • This is sometimes the hardest thing to do. The ultimate goal is for individuals experiencing a mental health crisis is to be safe. Sometimes even if we intervene and do all of the “right” things, individuals in crisis need more. If you get to that point and their safety continues to be a concern, don’t be afraid to refer for further evaluation and assistance. If you find yourself at that point and it is safe to, make sure you explain to the individual what you are recommend, why you are recommending it, and what will be happening next.
• Don’t be afraid to ask for help.
  • You are not expected to know all of the answers or how to help in all situations. Ask your co-workers and supervisors. Sign up for trainings. Learn from your past experiences. Even the most experienced practitioners continue to learn, grow and develop throughout their career.

There are of course many other things to REMEMBER and to DO and I do not know them all. As all of you, I will continue to learn and grow as I gain more experience and help more people. But hopefully, some of these are helpful, provided some reassurance, and let you know you are not alone.

Mental health crisis’ is something that all of us are susceptible to experiencing. Life can be difficult, and we all have a breaking point. Please always remember that the individuals and families that are in crisis are people first, crazies never.