A crisis can develop when people feel they cannot control their feelings or behaviors and are having trouble coping with the demands of everyday life. Potentially this can develop into outbursts of anger, violence, intense hopelessness or self-injurious behavior. When a loved one is in crisis, it can be hard to know what to do and how to help. In this blog I talk about features of a crisis that allow for you to assess risk level. I will discuss different strategies for managing a crisis based on level of risk (high-risk vs. low to moderate risk situations). I will also give you a some de-escalation tips and ways to express “effective” compassion. Finally I will address the areas you would want to cover in creating your own crisis plan for a client, a loved one or yourself.
Safety Concerns: What can you do?
1st you need to Assess Level of Risk!
High Risk Situation: Take action
Drive your loved one to hospital
Monitor your loved one, don’t leave them alone
Remove Lethal Means, e.g. weapons, pills, and sharp objects.
Moderate to low- risk situations:
Make contact – try to bring a feeling of calm and confidence into the situation. Practice active listening skills. Do not make judgments. Stay calm and supportive of your family member. Do not get into a shouting match however difficult their behavior, and even if you are hurt by what they are saying.
Try to learn what happen – don’t be surprised if your loved one is confused, vague or rigid: “nothing works”. Don’t get drawn into focusing on too much or too big of issues. Try to sort out one problem at a time. Acknowledge what your affected family member may be feeling or saying, let him or her know you have heard them and are trying to understand what they may be feeling.
Examine Choices – Your loved one must be involved in the problem solving. The first step is to find out what he/she has tried. Don’t rush in with the solution. Remember, solutions that are given too early, will be rejected. Guide your loved one into the solution. Examine obstacles to the plan.
Build a support network – involve anyone your loved one may be able to use as a support. Tell your loved one that talking about suicidal feelings and a thought was the right thing to do. Don’t be afraid to ask about suicidal intentions. Suicidal behaviors can be an attempt to relieve emotional pain or communicate distress
- Keep your voice calm
- Use short sentences
- Listen to their story
- Offer options instead of trying to take control
- Ask ho you can help
- You may want to avoid touching
- Remain calm, avoid overreacting
- Move slowly
- Don’t argue or shout
- Express support and concern
- Keep simulation level low
- Avoid eye contact
- Be patient and accepting
- Announce actions before initiating them
- Give them space, don’t make them feel trapped.
- Validated the valid versus trying to prove (or get them to see) your point.
- Acknowledged the difficulties they face, as well as their current distress
- Remind them that you will support them in using their skills
- Identify skills that might be helpful in the situation
- Coach them on using the skills
- Be flexible and willing to try different approaches to the problem
- Identify your own limits an communicate them clearly and non-judgmentally, as soon as possible
- Reinforce, cheerlead, and encourage each small step taken toward safety, wise mind and skill use.
Most importantly – SAFETY FIRST! In a crisis situation, when in doubt, back off or get out.
Creating a Crisis Plan
- Patient information – name, age, mental health diagnosis, medical history, list of strengths and interest.
- Family information – name of parents, list of family members, etc.
- Behaviors – Things that trigger (present before behavior occurs), list of strategies that have worked in the past (Skills)
- Medication – name and types of medications, dosage, prescribing physician’s name and phone number. Known allergies
- Treatment Choices - List of interventions or treatment currently being used, list of interventions that have not worked in past, treatments that should be avoided, list of treatment preferences.
- Professional involvement – phone numbers of crisis team! Family doctor, therapist, social worker, psychiatrist and hospitals with psychiatric units
- Supports – people who patient has trusting relationship with such as neighbors, friends, family members, teacher, etc.
- Safety Concerns – Access to guns, knifes or weapons, access to medication, both prescription and over the counter. Emergency contact names and phone numbers.
- Resources – advocacy organizations, support groups, hot-lines.