In a recent post, I covered the ten essential values for responding with compassion to a mental health crisis. These values came from the “Practice Guidelines: Core Elements in Responding to Mental Health Crises,” published by the US Substance Abuse and Mental Health Services Administration (SAMHSA).
This time around, let’s do a brief recap of the second half of the guidelines, which outlines 15 key principles for enacting those essential values in our mental health crisis intervention practices. (As I noted before, the document is in the public domain and can be reproduced freely, so I’ll quote extensively from it.)
1) Access to supports and services is timely.
Timely access to mental health crisis response services should include 24-hour/7 days a week availability and some capacity for outreach when the person is unable or unwilling to come to a traditional service site.
2) Services are provided in the least restrictive manner.
Least restrictive interventions avoid the use of coercion and preserve the person’s connections with their support networks. The person should be permitted and encouraged to make contact with professionals, family and friends who can offer assistance through the crisis period and beyond.
3) Peer support is available.
Crisis services should provide opportunities for contact with others with lived experience of mental health issues and crises. Peers can offer hope and opportunities for connections with a supportive circle of people with shared experiences.
4) Adequate time is spent with the individual in crisis.
In many emergency settings, there can be intense pressure to move patients through quickly. Health care personnel in these settings must regard the face-to-face time with the person in crisis as a core element of quality crisis care.
5) Plans are strengths-based.
It’s a common practice to focus on clinical signs and symptoms during a crisis. Yet, appropriate crisis intervention also should focus on the person’s available or potential strengths and assets. This helps to build resilience and increased capability to manage future crises.
6) Emergency interventions consider the person’s overall plan of services.
The crisis response should consider whether the crisis is due in part to gaps or other problems in the person’s current plan of care and provide crisis response that is consistent with other services the person is receiving.
7) Crisis services are provided by individuals with appropriate training and competence.
Crisis interventions demand a high level of skill, so all interveners (health care professionals, peers, first responders) should have an appropriate level of training and competence to address the person’s current needs.
8) Individuals in a self-defined crisis are not turned away.
People who seek crisis services but who do not meet the service criteria should receive meaningful help to find alternative resources. For example, if someone does not meet the criteria for inpatient hospitalization, it is not sufficient to tell the person or family to make contact again if the situation worsens. Help in accessing services to resolve issues early on should be provided.
9) Interveners have a comprehensive understanding of the crisis.
An appropriate understanding of the crisis includes not only what is happening at the moment but why it is happening and how the person fares when they are not in crisis. Recurrent crises likely signal a failure to address underlying issues appropriately.
10) Helping the person to regain a sense of control is a priority.
Regaining a sense of control over thoughts, feelings and events is extremely important for a person in crisis. The person should be allowed to participate as much as possible in decisions about care and treatment options. Recovery plans or advance directives can be helpful tools to operationalize this principle.
11) Services are congruent with the culture, gender, race, age, sexual orientation, gender identity, health literacy and communication needs of the person in crisis.
All of these variables can impact how the person responds to and manages a crisis situation. Therefore, interveners must take steps to address the impact of these personal factors while addressing the mental health crisis.
12) Rights are respected.
Many basic human and legal rights must be honored and upheld in a mental health crisis, including, but not limited to confidentiality, privacy, right to legal counsel, freedom from unwarranted seclusion and restraint, right to have an advance directive, and making informed decisions about treatment and medication.
13) Services are trauma-informed.
Many persons in a mental health crisis have a past history of traumatic experiences. It’s essential for a crisis response to safely and sensitively evaluate the person’s trauma history and the person’s current status with those issues, as their response to the current crisis may reflect past traumatic reactions.
14) Recurring crises signal problems in assessment or care.
Many individuals experience recurrent mental health crises and may be known in the system as high frequency users. Recurrent crises often signal a failure in the ability of the system to achieve a positive outcome of care. These individuals need a careful reappraisal of their needs in order to help them reduce their likelihood of further frequent crises.
15) Meaningful measures are taken to reduce the likelihood of future emergencies.
Mental health crisis interventions must always focus on lowering the risk of future episodes. This requires good crisis services, good recovery planning and an understanding of how all services for the person fit into the overall system of care. Collaboration among all persons and services who work with the person in crisis can go a long way to ultimately improve the level of care and reduce future crises.
I encourage you to thoroughly review the full text of these excellent guidelines and use them as a tool for more effectively managing, minimizing or perhaps even preventing future mental health crises. Whether you are a person who has experienced a mental health crisis first-hand, a friend or loved one of someone in crisis, or a crisis intervener, I believe you will find much useful information to bring about more compassionate response to mental health crises.
Here’s a question: Given this information, what can you do to reduce the impact of potential future mental health crises? 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!