Crisis Intervention
Welcome to Sojourner Recovery Services’ training on Crisis Intervention. Below you will find some general information on this subject as well as agency guidelines about how we provide crisis intervention. This is not intended to be a comprehensive training and further training may be required. If you have questions or concerns, please contact your supervisor or an administrator.
Purpose:
This training is intended to provide basic information regarding crisis intervention, and assessing a client who is suicidal or in crisis.
Introduction:
The goal of crisis intervention is to provide or help obtain services necessary to stabilize the crisis for individuals who have unstable medical or psychiatric problems or who are experiencing withdrawal symptoms. It is the responsibility of the staff conducting the assessment that clients be referred to the appropriate level of care.
When assessing someone in crisis, it is important to be safe. This is the cardinal rule of crisis intervention—your safety and the safety of the other person.
Crisis intervention is a face to face service provided to clients, families and significant others. In a crisis, ask the person in crisis how you can be helpful to them. Sometimes we forget to ask things like what can I do to be helpful to you? For some clients, a divorce is a crisis; for others it may be the most joyous day of their life; others might be indifferent. We may also forget to ask clients if they have ever dealt with anything like this before, how they handled this in the past, or if they have any ideas for resolving the situation that they are considering.
So, what may be a crisis for one client may not be considered serious when experienced by another client. Some problems can develop abruptly, while others develop slowly over time. Some problems represent an emergency and require an immediate intervention and stabilization. Most are urgent and require evaluation or attention within 3 days.
Problems generally fall into one of 4 categories:
1. Emergency problems usually require immediate assistance. These are situations which include dangerous, threatening, violent, self-harming, destructive, or suicidal behavior. A significant risk of violence or risk of suicide may be involved.
Reports of abuse, especially child abuse or abuse of the elderly, is considered in this category as well.
Some conditions that may be observed include mental and emotional problems that have not been evaluated and may be caused by a medical problem, strange behaviors that have not been evaluated or treated, or conditions in which taking or failing to take medications may be causing or may cause significant physical, mental, or emotional harm.
2. Crisis Problems usually require assistance within 24 hours. These are emergency problems that have been evaluated by a qualified professional and, based on that evaluation can wait until the next available appointment within a 24-hour time frame.
Potentially harmful or self-harming behavior, including reports of abuse where there is no immediate risk of violence fall into this category.
3. Urgent Problems are those that can be addressed safely within 3 days.
Reports of psychological and/or social problems that disrupt important activities, as well as exposure to or involvement in a traumatic event or experience occurring in dangerous circumstances, a loss of life, a serious injury, a life threatening experience or physical assault may fall in this category.
4. Routine Problems include a behavior or a pattern of symptoms that may lead to additional problems, become more difficult to change, or urgent problems in the future (but not immediate future).
In these situations, the client is competent, knowledgeable and familiar with the current problem or issue, and based on that knowledge is comfortable and willing to wait for a convenient appointment.
Suicide Intervention
In the U.S., a person dies about every 16 minutes from suicide, and an attempt is made every minute of every day. In the overall population, it is the 11th leading cause of death in the United States. Alcohol is a factor in 30% of completed suicides and approximately 7% of persons with alcohol dependence will die by suicide.
Past history of suicide attempts makes a person up to 50% more likely to complete suicide. A family history of suicide makes suicide a less taboo way of coping.
Schizophrenia, bi-polar disorder, post traumatic stress disorder, depression, and eating disorders are common psychiatric disorders among the general population and factor into becoming suicidal. Depression is present in at least 60% of completed suicides and attempts.
As you approach the scene of a suicidal crisis, here are the signs you should look for:
· Precipitating Event: such as loss of some kind: death, career, divorce
· Intense Emotions: anguish, rage, tension, anxiety, guilt, hopelessness
· Change in speech: “my wife would be better off without me,” talk that sounds like the person is saying good-bye or leaving a list of things that people should do after his/her death
· Change in actions: buying a gun, putting affairs in order
· Deterioration in functioning in social or work situations
· Increased use of alcohol, loss of control, rage explosions or other self-destructive behaviors.
Steps to Take:
1. Quickly identify the risk factors
· High risk group? (male, elderly, youth, mental illness, chronic illness, gay/lesbian)
· Expressing hopelessness
· Under the influence of alcohol or drugs
· Faced with a ‘no win’ situation
· Recent loss
· Hostile/poor impulse control
· Past suicide attempts
2. Look for the warning signs
· Talk of no reason to live
· History of substance abuse, recent recklessness
· Disheveled personal appearance
· Preoccupation with death
· Loss of interest in activities and withdrawal from friends and family
· Suicide of a significant other
· Unwillingness to connect with you
3. Assess lethality
· Ask directly about suicide;
· Do they have a plan?
· How detailed is the plan?
· How are they going to do it?
· Do they have access to the planned means?
Once the situation has been assessed, it is the staff’s responsibility to take action
· Notify on-call supervisor.
· Contact family member/support person to transport client to Ft Hamilton Hospital for adult clients and Children’s Hospital Medical Center for adolescent clients to be assessed.
· If there is an identified plan or steps of the suicide process have begun, call CAPS at 894-7002 for an assessment. CAPS is to be utilized for clients who are unable to be transported or if client is a threat to self or others.
· Place client on suicide watch (extra close monitoring, 15 minute bed checks).
· If a client attempts suicide, call 911 immediately. When applicable, administer first aid/CPR until EMS arrives. Gather all pertinent medical information, including medications and emergency contact. Have this information ready when EMS arrives. If the client is an adolescent, contact parent and/or legal guardian and notify them of situation and that they must meet the client at the hospital immediately. Contact on-call supervisor.
· Complete Incident Report located on the F drive. Send a copy to Program Director and to the Executive Vice President.
Don’t
· Ask why
· Make promises you cannot keep
· Minimize their negative feelings
· Use guilt or shame about how this would affect others
· Argue about moral, ethical, or religious issues
Do
peers and supervisors after the crisis is taken care of.
Quiz Instructions:
1. Click on the link below to access the quiz
2. Print the page
3. Complete the quiz
4. Submit the completed quiz to your supervisor