Having worked for many years as a clinical psychologist in a busy psychiatric hospital, I saw mental health emergencies and crises just about every day. These included a wide variety of challenging situations, including statements or actions related to self-harm or harm to others, and traumatic experiences related to abuse, victimization or other horrific experiences.
In addition, drug or alcohol use, psychosis and mania were other contributing factors to many crises, and the situation sometimes became further complicated by work or family conflicts, lack of treatment, medical conditions, discrimination and even incarceration or homelessness.
Although responding to these types of crises was a part of our typical work routine, our hearts always went out to those we were helping and we tried our very best to provide safe and compassionate care during these very difficult moments.
Given my experience with mental health crises, I was intrigued to find a document online called, “Practice Guidelines: Core Elements in Responding to Mental Health Crises.” It was published by the US Substance Abuse and Mental Health Services Administration (SAMHSA). I’ll refer to this document as “the guidelines.” (The document is in the public domain and can be reproduced freely, so I’ll quote extensively from it.)
The guidelines focus most specifically on individuals with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. However, they are also applicable to all people who may experience a mental health crisis.
What it means to be in a mental health crisis
The guidelines provide a helpful discussion about what it means to be in a mental health crisis. The important point is made that danger to self or others, while often a component of a mental health crisis, is too narrow a focus. Mental health crises can and do often include other concerns such as intense feelings of personal distress (anxiety, depression, panic, anger hopelessness), a decline in personal functioning (neglect of personal hygiene, unusual behavior), or catastrophic life events (relationship conflicts, decreased social support, housing problems, loss of rights or autonomy, vicitimization or natural disasters).
Because of this wide array of issues, a response to a mental health crisis that is only based on physical safety is often too little, too late, or no help at all in addressing the root of the crisis. Therefore, the guidelines attempt to define appropriate responses and essential components for better managing the whole spectrum of mental health crises. The two overarching goals of the guidelines are to ensure that crisis interventions are consistent with standards of recovery and resilience and to work toward reducing the likelihood of future emergencies and to bring about better outcomes.
Ten essential values
The guidelines outline ten essential values that should be included in all responses to mental health crises. I’ll give a brief recap here, but I encourage you to read the complete description in the guidelines.
1) Avoiding harm – Consider the risks and benefits of any crisis intervention. Options may include “watchful waiting” if acute harm can be safely managed. If there are urgent safety issues, make sure the crisis response minimizes the negative impact of the interventions used.
2) Person-centered – Crisis interventions should seek to understand the person, their unique circumstances, and how their preferences and goals can be incorporated into the crisis response.
3) Shared responsibility – An appropriate crisis response seeks to help the person to regain control by considering them an active partner in their health care rather than a passive recipient of services.
4) Addressing trauma – Any harm resulting from the crisis should be evaluated and addressed without delay. The person should make important aspects of their trauma history and personal vulnerabilities available to crisis responders to assist them in appropriately modifying the crisis response to minimize further negative effects.
5) Personal safety – Assisting the person in crisis to feel safe is paramount. Ask them what helps them feel safe and secure or consult their crisis or safety plan if one is available. Also find out what situations increase their feelings of vulnerability so they can be avoided or carefully managed.
6) Based on strengths – Seek to identify and reinforce personal strengths and resources on which the person can draw, both to recover from the crisis and to help protect further occurrences.
7) The whole person – While the person’s mental health needs may dominate the crisis and its response, remember that a person in crisis is still a whole person. Accordingly, they may also have other needs, including medical, family, social, cultural, and spiritual concerns, which also need to be addressed. Practical concerns will often need attention, such as care of children and pets, absence from work, securing one’s car and house, paying bills, and so on.
8) The person as a credible source – In crisis, a person with mental illness may make statements that may be dismissed as irrational or delusional. Consequently, legitimate complaints regarding health, pain, abuse, or victimization can be ignored. An appropriate crisis response does not dismiss the person as a credible source of information.
9) Recovery, resilience and natural supports – An effective crisis response helps the person continue their journey toward recovery and resilience by preserving their dignity, fostering a sense of hope, and promoting engagement with both formal health care systems and informal support resources.
10) Prevention – A response to a mental health crisis should also work to ensure that recurrent episodes will be minimized by evaluating possible relapse factors and other risk factors for ongoing difficulties. Unmet needs must be addressed through individualized planning and by promoting improvements to the overall mental health care system.
Whether you are a person who has experienced a mental health crisis, a friend or loved one of someone in crisis, a crisis responder or a health care provider, I think we can all benefit by carefully reviewing these values and by incorporating them into our future management of mental health crises. Communication, collaboration, and planning among all concerned parties can make a difference in how we manage mental health crises with greater care and efficiency in the future.
In an upcoming post, I’ll talk more about mental health crisis responses, and detail 15 important principles for bringing the ten essential values to life in our crisis intervention practices. Stay tuned.
Here’s a question: What has been your experience with mental health crises, and what can we do to improve our response to such situations? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on X (formerly Twitter), “like” my Facebook page, or connect on LinkedIn. Finally, if you enjoyed this article, please share it with a friend!