crisis and its intervention BY: Dr.Sukhbir Kaur Associate Professor SGRD College of Nursing, SGRD University of Health Sciences, Amritsar.

1. Unit : XIII
PSYCHIATRIC EMERGENCIES AND CRISIS
INTERVENTION

2. Definition:
• Crisis:
• Crisis is a perception or experiencing of an event
or situation as an intolerable difficulty that
exceeds the person’s current resources and
coping mechanisms.
(James & Gilliland, 2001)

3. • Crisis Intervention:
• Crisis intervention is emergency first aid for mental health
& domestic violence. It requires that the person experiencing
the crisis receive timely and skillful support to help cope with
his/her situation before physical or emotional deterioration
occurs.
• Crisis intervention therefore involves three major components:
• The actual crisis – victim’s perception of an unmanageable
situation,
• The individual in crisis, and
• The helper who provides aid.

4. • A stressful event alone does not constitute a
crisis; rather, crisis is determined by the
individual’s view of the event and response to it.
(Smead, 1988).

5. Types of crisis :
1. Dispositional crisis : an acute response to an
external situational stressor.
2. Crisis of anticipated life transitions : normal life
– cycle transitions that may be anticipated but
over which the individual may feel a lack of
control.

6. 3. Crisis resulting from traumatic stress: crises
precipitated by unexpected external stresses
over which the individual has little or no
control and from which he or she feels
emotionally overwhelmed an defeated.
4. Maturational / development crisis:- Crises that
that occurs in response to situation that trigger
emotions related to unresolved conflict’s in
one’s life.

7. • 5. crises reflecting psychopathology:- emotional
crises in which pre-existing psychopathology has
been instrumental in in precipitating the crisis
e.g, personality disorders.
• 6. Psychiatric emergencies :- crisis situation in
which general functioning has been severely
impaired and individual rendered incompetent
or unable to assume personal responsibility.

8. Characteristics of a Crisis:
• Time limited: Generally lasting no more than six
weeks.
• Typical phases:
▫ Traditional attempt to problem solve
▫ Attempts to try alternative methods
• Disorganization
• People are more open to change
• Opportunity to resolve previously unresolved
issues
• Successful experience

9. • It is precipitated by specific identifiable events.
• Crises are personal by nature.
• Crises are acute not chronic.
• It contains the potential for psychological
growth or deterioration.

11. Process or phases of crisis:
• Phase 1 : the individual is exposed to
precipitating stressor.
• Anxiety increases , previous problem solving
techniques are employed.

12. • Phase 2 : When previous problem solving
techniques do not relieve the stressor, anxiety
increases further.
• Feeling of confusion and disorganization
prevails.

13. • Phase 3 : All possible resources both internal
and external are called on to resolve the problem
and relieve the discomfort.
• New problem solving techniques may be used.

14. • Phase 4 : if resolution does not occur in previous
phases , major disorganization of the individual
with drastic result often occurs.
• Anxiety may reach panic levels, cognitive
functions are distorted., emotions are labile and
psychotic thinking can develop.

15. Auguilera
and
Messick
crisis
model –
(1982)

16. Crisis Intervention
• Goal is to stabilize the family situation and
restore to their pre-crisis level of functioning.
• Opportunity to develop new ways of perceiving,
coping, and problem-solving.
• The intervention is time limited and fast paced.
• Worker must take an active and directive
approach.

17. • “Principles of Crisis Intervention:
• Simplicity – People respond to simple not complex
in a crisis
• Brevity – Minutes up to 1 hour in most cases (3-5
contacts typical)
• Innovation – Providers must be creative to manage
new situations
• Pragmatism – Suggestions must be practical if they
are to work
• Proximity – Most effective contacts are closer to
operational zones
• Immediacy – A state of crisis demands rapid
intervention
• Expectancy – The crisis intervener works to set up
expectations of a reasonable positive outcome”

18. Process
• Phase 1 : Assessment
• Phase 2 : Planning
• Phase 3 : intervention
• Phase 4 : Termination or evaluation of crisis
resolution and anticipatory planning.
• Assessment includes: the stressor event; the
person experiencing the crisis; and the meaning
of the event to the person in crisis.
• Important to assess risk factors.

19. Risk Factors
• Suicide or homicide
• Risk of physical or emotional harm to the
children
• Risk of break from reality (psychosis)
• Risk of client fleeing the situation.

20. Performing the Assessment
• Conducting the interview
▫ History: personal and familial of risk behavior
▫ Any means and plans the client may have about
carrying out the risk behavior
▫ Controls: internal and external that are stopping the
client from undertaking the risk behavior.
• Observations during the interview
▫ Level of anxiety; desperation; despair; sense of
hopelessness; contact with reality.

21. • The skill and technique most essential at this
stage is that of focusing while allowing the
client to ventilate and express the overwhelming
flood of emotions.
• Focusing technique can elicit more coherent
information for assessment as well as help the
client pull themselves together cognitively and
emotionally.
• A focused interview can serve as an instrument
of both assessment and intervention.

22. Intervention
• Planning occurs simultaneously as assessment is
made about how much time has elapsed between
the occurrence of the stressor event and this
initial interview.
• How much the crisis has interrupted the
person’s life;
• The effect of this disruption on others in the
family;
• Level of functioning prior to crisis and what
resources can be mobilized.

23. • The goal of intervention is to restore the person
to pre-crisis level of equilibrium, not of
personality changes.
• Worker attempts to mobilize the client’s internal
and external resources.
• Exact nature of the intervention will depend on
the client’s pre-existing strengths and supports
and the worker’s level of creativity and
flexibility.

24. Dealing with Crisis Behavior
• Be supportive
• Be calm
• Be honest & direct
• State your concern
• Don’t act shocked or surprised
• Gather pertinent information
• Refer to counseling

25. Three Approaches
• Affective:
▫ Expression and management of feelings involving techniques of
ventilation; psychological support; emotional catharsis.
• Cognitive:
▫ Helping the client understand the connections between the
stressor event and their response. Techniques include clarifying
the problem; identifying and isolating the factors involved;
helping the client gain an intellectual understanding of the crisis
▫ Also involves giving information; discussing alternative coping
strategies and changing perceptions.

26. • Environmental modification:
▫ Pulling together needed external, environmental
resources (either familial or formal helping agencies)
• Any and all three approaches may be used at any
time depending where the client is, emotionally
and cognitively.
• The goal is to help the client restore pre-crisis
levels of functioning.

28. PERSONNELS WHO PROVIDE CRISIS INTERVENTION:
• psychiatrists
• • psychologists
• • counsellors
• • fire fighters
• • emergency medical staff
• • search and rescue staff
• • police officers
• • doctors
• • nurses
• • soldiers
• • clergy
• • communications personnel
• • community members
• • hospital workers and so on.

29. Warnings
• Danger of misunderstanding the client’s
nonverbal behavior as well as spoken words due
to cultural differences or the client’s state of
disorganization.
• Imperative for the worker not to assume that
they understand what the client means by his
spoken word or non-verbal behavior and vice
versa.
• It is best to clarify and make sure.

30. TECHNIQUES OF CRISIS INTERVENTION:
• 1. Critical Incident Stress Management –
CISM is a comprehensive, organized
approach
• for the reduction and control of the harmful aspects
of stress in the emergency services.
• It is a comprehensive, integrated, systematic
intervention containing multiple tactics to
• dealing with the crisis after traumatic events. CISM
is a coordinated programme of
• tactics, linked together to alleviate reactions to
traumatic events.

31. • 2. Critical Incident Stress Debriefing –
CISD is a seven step, group psychological
• process developed as a method for mitigating the
harmful effects of work-related trauma
• and mitigating post-traumatic stress disorder.

32. • 3.Medical Crisis Counselling – This is a
brief intervention used to address
psychological
• and social problems related to chronic illness in
a health care setting. It uses coping
• techniques and builds social supports for the
patient to cope with the stress of the
• diagnosis and their responses to the stressful
circumstances.

33. • 4. Psychological Debriefing
• Psychological debriefing is a structured group
meeting where participants are able to
• review traumatic events that they have
experience and how they have responded to it.
• What is debriefing? Debriefing is a specific
technique that is used to help others deal
• with the physical and psychological symptoms
associated with exposure to a trauma.
• Debriefing allows those involved to process the
event and reflect on the impact of it.
• Debriefing should usually occur near the site of
the event.

34. Summary:
• A crisis is a disturbance resulting from a
perceived threat that challenges the person's
usual coping mechanisms. Crises are a time of
increased vulnerability, but they can also
stimulate growth. There are two types of crises:
maturational and situational.
• Crisis intervention is a brief, active therapy
with the goal of returning the individual to a
precrisis level of functioning.

35. • In assessing a patient the nurse should identify
the patient's behaviors, precipitating event,
perception of the event, support systems and
coping resource, and previous strengths and
coping mechanisms.
• The expected outcome of nursing care is that
the patient will recover from the crisis event
and return to a precrisis level of functioning.
Levels of crisis intervention include
environmental manipulation, general support,
generic approach, and individual approach.

36. • The nurse and patient should consider the following
factors in evaluating nursing care: the patient's level of
functioning, symptoms, coping resources, coping
mechanisms, evidence of adaptive coping responses,
and need for referral for further treatment.
• Crisis intervention can be implemented in any setting,
including hospitals, clinics, community health centers,
and the home. It should be a competency skill of all
nurses.
• Modalities of crisis intervention include mobile crisis
programs, group work, telephone contacts ,disaster
response, victim outreach programs, and health
education.