10.18.2011

Application and Analysis of Crisis Intervention Strategies



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 By Elizabeth Hall

Introduction
In modern day society, with the fast pace that everything moves and changes, people have less patience in general, and the state of the world’s economies, it is not unlikely that the field of mental health has responded with the addition of the specialist known as the crisis intervention professional.  This professional serves as a bridge between mental health services and the police.  The position and stance is created out of need when Congress passed the Community Mental Health Centers Construction Act in 1963, because deinstitutionalization of the mentally ill became the new plan.  According to Bird, Coffin, Hartley, and Lambert (2002), this act provided funding to create facilities and programs to aid the mentally ill with the following services, outpatient, inpatient, consultation, temporary hospitalization orders, and along with crisis and emergency intervention services.  In this paper, we will discuss crisis intervention services and responses through two case studies of people experiencing crises, what we as crisis workers need to effectively intervene in a crisis, the Six-Step Model of intervention, client interaction, and safety concerns for the crisis intervention professional. Case I Scenario- Suicide Survivor 
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In this scenario, the crisis worker is called out to a scene, to intervene when a woman is distraught over the suicide of her husband.  She is having difficulty in dealing with her circumstances, and for this paper, we will name her Laura Breemer.  As noted by the Association of Suicidology (2004), persons who survive a loved one’s suicide are often left with feelings beyond those of a loss from another type of death.  Beyond the general grief over the loss of a loved one, the survivor left behind may suffer from extreme guilt and or feelings of fault for not catching the signs and preventing the death, or of not supporting and recognizing the problem that the person in crisis is experiencing.  One of the issues in dealing with this type of crisis holds the American Association of Suicidology (2004) is that the survivor is aware that their life will never be able to return to pre-crisis status, which is important for the crisis intervention worker to remember when interacting with this client. 
Upon arrival to the scene, we find a middle-aged woman in a middle class neighborhood on the sidewalk waiting for us.  The client is in her living room having just had a conversation with her neighbor who made the call and is outside waiting for us.  The woman is surprised to see us, at her door, as she is unaware that her neighbor made the call.  She appears to have been crying for a long period, as her eyes are red and swollen but she lets us in.  She also appears extremely tired and agitated, and barely looks up at all, as her eyes are looking at a piece of paper on the table in front of her.
Information Needed
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It is our job as crisis intervention professionals to acquire information at this scene, so we can effectively assess the situation, provide support, and reach a satisfactory end to the crisis in which no one gets hurt, and the woman can step in the right direction for resources to resolve the problem.  Before knocking on the client’s door, we have spoken with the neighbor, ascertaining that the woman and her husband had lived in the neighborhood for years, and she knew them well.  The neighbor tells us that they were a happy couple, until a few months ago when the husband, Pete, was fired from his job for embezzlement.  Since the suicide, Laura has been alternately angry and distraught over the facts she has uncovered about her husband, and the financial state she has now been left in, as she was unaware that they had been having financial difficulty, or of any of her husband’s actions at work until the suicide.
The client continues to stare down at the piece of paper on the coffee table, motionless and deflated.  We need to obtain the following information from her according to James (2008), the scope of the crisis at hand, what her present mental state is, in tangible terms, if she is under the influence of alcohol or drugs, and whether or not she presents intent to harm herself or others. Without this information, it is unlikely that we can effectively counsel Laura, or help her find the resources she needs to help her out of this crisis state.  In the process of gaining this information, we are beginning the steps of the six-step model of crisis intervention (James, 2008). 
Case Intervention Application: Six-Step Model
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One of the models used in successful crisis intervention strategies is called the six-step model, and serves to provide crisis workers with a framework to deal with situations involving the mentally ill or people presenting in crisis states (James, 2008).  The first step in this process is the act of defining the nature and scope of the present crisis.  We received some information from the neighbor, which will make it somewhat easier to talk to Laura; however, we do need more information than we have.  The process calls for the first step to be defining the crisis (James, 2008), so we begin by asking Laura if she will be willing to talk to us, as we are here to help her.
In defining the crisis, what we learn from the empathetic conversation with Laura is that she is used to living a comfortable life with a reliable partner, who has been harboring financial crisis from her.  Now she is stuck with bills she cannot pay, because all of their assets were seized due to the investigation of embezzlement, and is experiencing intense grief and anger about her husband’s suicide.  The next step is to ascertain the safety of the scene, along with the client’s danger to herself or others.  Laura confesses that she is having trouble finding reasons to go on; however, she does not have any weapons or means of committing suicide in her near proximity, so it is unlikely that she will do anything rash at the scene.
 Her mental state is distracted and distraught however so she will need to be referred to a long-term therapy counselor,  and the local offices of the Cabinet for Families and Children which can help her with resources for food, shelter, medical programs, and help paying utilities and other essential bills.  We talk with Laura for a while, actively listening to her describe her feelings about the situation, as required in the third step of the process.  During the conversation, we discuss that the Cabinet for Families and Children can help her find most of the resources she needs, including providing access to counseling at little to no cost, and give her the address of a suicide grief group that meets every week to aid survivors in the recovery process after losing someone to suicide.  This covers the third step, providing support and active listening skills, and the fourth step, examining alternatives to Laura’s present solution, which is committing suicide herself (James, 2008). 
During this conversation, Laura expresses that she was unaware that programs even existed that she could turn to for help, and seems to be less agitated and distraught, although still depressed.  She does however agree that she needs some help, says that she is not on any drugs or alcohol, and expresses appreciation for the information on the programs.  We look up the suicide grief program on the computer, and learn that there is a meeting this evening.  Laura expresses that she would like to attend the meeting, and promises that she will attend.  We discuss her going to the Cabinet for Families and Children, and she promises that she will go down there the following morning.  This satisfies the requirements for steps five, planning alternatives, and step six, obtaining a commitment from the person in crisis (James, 2008) and we have successfully averted the crisis by following the six-step model of crisis intervention.  
Case II Scenario- Psychotic Disorder
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We will now move on to our second scenario, which involves the serious mental implications of a psychotic disorder such as schizophrenia or bi-polar disease.  In this scenario, we are called out to a scene involving a man who is in the downtown area with absolutely no clothing on his body.  Witnesses report that he is talking about UFO’s, insisting that they are coming down to get him.  Upon arrival at the scene, we note that he is disheveled, and dirty, agitated, and ranting.
Assessment of Mental State
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In this situation, we will call our client Christopher Smith, and we notice immediately when we arrive at the scene that this crisis involves serious mental illness.  Witnesses who happened to be present when Christopher began his ranting provide the only background we have on this situation.  It is our job as crisis intervention workers to follow the six-step model, and avoid a catastrophe, which can arise in situations that involve serious mental illness and delusional clients.  In this case, according to the Mayo Clinic (2011), both the manic phase of bi-polar disorder, and paranoid schizophrenia cause delusions of this nature, and it is becoming obvious that we will need to refer Christopher to a mobile mental health unit because he is delusional, may pose a threat to himself or others in this delusional state.
Case Intervention Application: Interaction with Client
Upon approaching Christopher, it is important to follow the six-step model since this is the model we have elected to use (James, 2008), even though it is obvious that he is delusional.  We must make contact with him, in order to assess and define the problem, which is the first step in our model.  Because he is obviously delusional, it is important to approach with caution, as we must maintain the safety of everyone.  In this approach, we must maintain empathy for the client (James, 2008), as he firmly believes that UFO’s are coming down to get him, and he is not happy about this.  Defining this crisis amounts to gathering whatever information we can get from Christopher.  This results in ascertaining that Christopher is not currently self-medicating with drugs or alcohol but little else. 
Case Intervention Application: Securing Safety
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Since we have completed the first step in the model, defining the problem, we must now secure the safety of the client, the crisis counselor, and the people around the scene.  Since Christopher is clearly delusional, according to Antai-Otong (2001), and emitting bizarre behavior, this makes the crisis urgent, and the correct step to follow to ensure the safety of all persons involved means that we must contact the police.  The police will transport the patient to the nearest mobile mental health unit or community clinic, for stabilization with a long-term therapist.  More and more often in modern times, since the deinstitutionalization of the mentally ill, police are the first responders to situations such as this, so they are now trained on how to interact with mentally ill clients (James, 2008). 
Conclusion
Since the passage of the Community Mental Health Centers Construction Act of 1963, services for mentally ill people have been moved from facilities that housed and treated them for long periods of time to community mental health centers which offer more individualized services, but shorter lengths of treatment times (Bird, Coffin, Hartley, and Lambert 2002).  This has created the need for specialized crisis intervention workers to assess and manage those persons with mental illness or situational crises.  Through exploring the crises that Christopher and Laura experienced, we were able to examine the six-step model of crisis intervention and the processes that are involved in each step.  We have learned that while there are definite processes to utilize when professionals are intervening in a crisis, each case presents different challenges, and each solution is different.  The challenge to mental health professionals remains that they must be prepared to define the crisis, ensure the safety of all involved, and provide support and referrals to clients.  They should also examine all alternative options to help the client avoid continuing the crisis state, help them plan to carry out the alternative solutions, and finally they must elicit a commitment from the client to utilize the alternative solutions in all forms of crises.  According to James (2008), following specific procedural processes such as the six-step model, is the professional method used to ensure positive results when counseling a person through a crisis. 



Resources
American Association of Suicidology, (2004).  Helping Survivors of Suicide: What can You do?  Retrieved From: http://www.suicidology.org/c/document_library/get_file?folderId=229&name=DLFE-77.pdf
Antai-Otong, D. (2001).  Psychiatric Emergencies: How to Accurately Assess and Manage the Patient in Crisis.  Retrieved From: http://www.pagecomposition.com/samples/pdf/psychemer.pdf
Bird D. C. Ph.D., Coffin J., MS, Hartley D. Ph.D., MHA, and Lambert, D., Ph.D. (2002).  The Role of Community Mental Health Centers as Rural Safety Net Providers.  Retrieved From: http://muskie.usm.maine.edu/Publications/rural/wp30.pdf
James, R.K. (2008).  Crisis Intervention Strategies, Sixth Edition.  Cengage Learning.  United States
Mayo Clinic, (2011).  Bipolar Disorder: Symptoms.  Retrieved From: http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=symptoms
Mayo Clinic, (2011).  Paranoid Schizophrenia: Symptoms.  Retrieved From: http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862/DSECTION=symptoms




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1 comment:

  1. With the crisis intervention services,the individual is better equipped to cope with future difficulties.And also decreased distress and improved problem solving.
    Crisis Intervention
    Family Intervention

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