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Street Talk Newsletter

Communicating During Crisis

During a psychiatric crisis, safety for everyone on-scene is paramount. Some situations unfold very quickly and demand immediate action. But many offer opportunities to gather information, build some rapport through communication and listening skills, and create a safe, positive outcome. Here are some strategies to keep in mind when encountering a person in a mental health crisis.

No strategy is ever “sure fire” for every situation, but in some circumstances, they can make a big difference. And remember, there will be times when no matter how patient you are, how well you listen, communicate and empathize, the situation won’t resolve itself the way you might have liked. Some crises are just too severe.

Assume and maintain a calm, controlled demeanor. Keep your approach relaxed. Be polite and matter-of-fact. Do not act shocked by what you might hear. Remember: it’s not just what you say; it’s also how you say it. Reassure the person he/she is not in trouble and that you are there to help.

Minimize environmental stimuli. When possible, approach the scene without lights or sirens; keep radio chatter to a minimum. If you’re in someone’s home, encourage person to turn off radio, television or other visual and auditory distractions. Separate individuals if each other’s presence creates agitation or distraction.

Use the person's name frequently, especially if you are having trouble keeping his/her attention. Even the most psychotic person will usually respond to his/her name.

Encourage the person to sit down and take a few deep breaths if he/she appears to be hyperventilating or very anxious.

Use closed-ended questions if the person has trouble with attention, or you need to get specific information, e.g., “Heather, are you having thoughts of wanting to kill yourself?” or “Heather, are you taking medication?” Question family members whenever possible.

Use open-ended questions to get as much information as possible with a few questions, e.g. “Jerry, tell me what the voices are saying to you.” Question family members whenever possible.

Ask one question or give one direction/instruction at a time. Be concrete; repeat if necessary. Do not use professional jargon or elitist vocabulary.

Ask about hallucinations and medications. The only way to know for certain is to ask. For example, if someone states he/she hears voices, ask “What do the voices say to you, Jim?” You might need to ask a series of questions to determine if they are prescribed any medications, take any medications, and when was the last time he/she took medication or any other substances.

Acknowledge the person’s feelings rather than ignore them, e.g., “Sue, I can see you are very upset.” Validating feelings can also enhance rapport, e.g., “I’d probably be mad too if my neighbor called the police on me, but let’s try to straighten out what’s happened.”

Keep interactions reality-based. Orient the subject to person, place and time, e.g., “James, do you know where you are? Do you know what the date is? Do you know who I am?” In most cases it is not a good idea to “play along” with the hallucinations or delusions, e.g., “OK, Jesus, do you want to tell me what happened?” If the person experiencing delusions or hallucinations asks if you see or hear what he/she is perceiving, it’s OK to say “No”. On the other hand, it will seldom - if ever - be productive to try to talk the person out of his/her delusions or hallucinations.

Set clear, concise limits on behavior without being punitive or threatening, e.g., “Brian, I know you’re scared about going back into the hospital, but I need to get you to the emergency room.”

When appropriate, offer referral numbers to the individual or on-scene family members.See next article for contact information to key resources.