mental-health-crisis-strategies.md

# Strategies for Supporting Clients During a Mental Health Crisis

## Crisis Overview
- Crisis: "A perception or experiencing of an event or situations as an intolerable difficulty that exceeds a person's current resources and coping mechanisms." (James, 2008)
- A psychological reaction to a traumatic event.
- Crisis involves a perceived threat.
- When a person's coping mechanisms break down in the face of a stressor, crisis results.

## Principles and Characteristics
1. Crisis embodies both danger and opportunity for a person.
2. Crisis is usually time limited.
3. Crisis is difficult to resolve and complex.
4. Life experiences of crisis greatly enhances the effectiveness of helpers in crisis intervention.
5. Crisis contains the seeds of growth and impetus for change.
6. Quick fixes may not be applicable in many crisis situations.
7. Crisis confronts people with choices.
8. Emotional disequilibrium or disorganization accompanies crisis.

## Process of Crisis Intervention
1. Cushion the effects of the stressful event by providing immediate emotional and environmental first aid.
2. Help strengthen the individual's coping strategies through therapeutic guidance.
   - Focuses on current situation.
   - Involves assessment of safety, immediate needs, and needs for immediate services.
   - Requires access to resources.

## 6-Step Model of Crisis Intervention
1. Defining the problem.
2. Ensuring client safety.
3. Providing support.
4. Examining alternatives.
5. Making plans.
6. Obtaining commitment.

## Assessment in Crisis Intervention
- Assessment is intentional and ongoing.
- Supports determination of:
  - Severity of the crisis
  - Presenting emotional state
  - Emotional mobility/immobility
  - Coping mechanisms
  - Support systems
  - Danger to self or others
  - Process of de-escalating the crisis

## ABC's of Assessment
- Affective state
- Behavioural functioning
- Cognitive state

## Strategies of Crisis Intervention
- Creating awareness.
- Allowing catharsis.
- Providing support.
- Increasing expansion.
- Emphasizing focus.
- Providing guidance.
- Promoting mobilization.
- Implementing order.
- Providing protection.

## Conditions for Client Growth
- Communicating empathy.
- Communicating genuineness.
- Communicating acceptance.

## Suicide Assessment
- Multiple tools available.
- Initially, helpers are uncomfortable with the language.
- Clients have reported that they appreciated the directness of the language.
- May be some protest when encouraged to contact emergency services.
- Encourage the clients to commit to what is in their best interest and errs on the side of life.

## Creating a Safety Plan
Necessary elements of a Safety Plan:
1. Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be developing.
2. Internal coping strategies – Things I can do to take my mind off my problems without contacting another person (relaxation technique, physical activity).
3. People and social settings that provide distraction.
4. People whom I can ask for help
5. Professionals or agencies I can contact during a crisis.
6. Making the environment safe.

## Culturally Sensitive Crisis Intervention Plans
- Immigrant and Indigenous communities are two population groups in Canada that need greater support in the area of suicide prevention.
- Many individuals within these communities suffer from acculturative stress, which often occurs when someone is trying to adjust to a new culture.
- This stress can manifest through the victim's feelings of marginality, depression, anxiety, and identity confusion (Leach, 2006, p.169).
- The acculturation process can be so brutal at times that some may ultimately be driven to take their lives.

## Immigrant Suicide Risks
- Some may suffer from varying degrees of social isolation – especially if they are estranged from their close family members.
- The failure to reach their employment or economic expectations can cause feelings of utter hopelessness.
- Racial discrimination, language barriers, and the breakdown of community and family support structures are other serious factors that can contribute to disparaging conditions leading to a greater risk of suicide.
- Mental illness can also be a huge factor for individuals who experienced stress, trauma or hostile/wartime conditions in their homelands before moving to Canada.

## Aboriginal Suicide Risks
- Acculturative stress and marginalization for an Indigenous individual include failing to acquire and value Indigenous values and identity, while also failing to identify with the cultural values of the larger society.
- This stress can create a very dangerous state of limbo for people who are caught in the middle of this cultural battle, and can be repeatedly identified as a risk factor for suicide among Indigenous adolescents.
- Unfortunately, this stress helps to contribute to the highest suicide rates in all of Canada.

## Culturally Sensitive Approaches
- Be aware that minority individuals may be less likely to disclose suicidal information.
- Seek knowledge about different minority groups – specifically their cultural stance on suicide.
- Respect and be extremely sensitive to cultural differences when assessing for risk of suicide.
- Western views that therapy is a collaborative effort versus eastern views of the therapist as a learned teacher.
- Male views that revealing weakness to females is shameful, or similar views that favour nondisclosure to therapists.
- Cultural practices that favour a passive or non-participatory patient role, e.g. avoiding questions, waiting for a "cure" or "answer" from the doctor or healer.

## Enhancing Crisis Intervention
Making use of the following will support and often accentuate the intervention process:
- Make psychological contact
- Use grounding techniques
- Utilize breathing exercises
- Support the client in creating a psychological state of 'here and now' presence

## Wrap-Up
- Clients in crisis can evoke a strong emotional reaction in us.
- Keep a cool head, a focused mind, and a calm demeanor.
- Remind yourself that this client has capacities and capabilities to recover and grow from this moment.
- Your role is to support and guide the process.
- Your safety is critical.
- Know your exits.
- Often, admission to a mental health ward is the best option for clients who are unresponsive to crisis intervention support.

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Megan Phillips, RP
Phillips Psychotherapy Services
www.phillipspsychotherapy.ca
519-630-8233