FAMILIES IN CRISIS

1. FAMILIES IN CRISIS Chapter 5 – Crisis Case Handling 1

2. CRISIS CASES • Broader in Scope • Methodological treatment • Continuous feedback • Leisurely/weekly • More background info. • More psycho-educational • Seeking to change residual, repressive and chronic modes of thinking, feeling and acting • Personality change • Compressed scope • Best guess or set procedures • Here and now • Minutes/hours • Specific crisis info • Quick determination of coping skills, resources, • Movement to stability • Restoration of functioning LONG TERM CASES See Tables 5.1, 5.2, 5.3, 5.4 2

3. WALK-IN’S - TYPES OF PRESENTING CRISES • Chronic Mental Illness (often multiple problems with inconsistent care) • Acute Interpersonal Problems in Social Environment (runaways, crime victims, violent events, unemployed, etc.) • Combination of the two (fairly common) Note: Often with financial problems prohibiting private care 3

4. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC • Entry • Disposition of the case • Possible isolation • Case history • Thinking processes • Threats to self or others • Drug abuse • Psychiatrist may be needed 4

5. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT) • Commitment to inpatient facility may be needed • Voluntary • Involuntary (physician orders/evaluation and crisis trained transportation) 5

6. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT) • (If Coherent) Intake Interview • Written and verbal • Define the problem • Assess for client safety • Apprise the client of rights • Usually standardized intake sheet • Degree of lethality and drug use 6

7. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT) • Disposition • proposed diagnosis • treatment recommendations • Discuss with client • Client chooses to accept or reject • Next steps/therapists/clinical team meeting 7

8. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT) • Anchoring • Never left alone • Gain feeling of care and support • Structured/methodical orientation • Establishing rapport, support, encouragement, sense of security 8

9. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT) • Short-term Disposition (basic physical needs) • Long-term disposition (psychiatric or pharmacological evaluation) • With objectives, goals, and therapeutic plan and regular review of plan • 24 hour telephone service/hotline • Evaluating and referring 9

10. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT) • Mobile Crisis Teams/Police • When client is out of control and unwilling or unable to go to the clinic • Jail is frequent 10

11. CRISIS INTERVENTION TEAM (CIT) • Train Patrol officers to deal with the mentally ill and emotionally disturbed • Utilizing Mental Heath Experts and Providers • Including relationships with other community and medical resources • De-escalation and diffusing techniques • Fishbowls (Trainees observe discussions with patients and mental health professionals) 11

12. SUICIDE BY COP • People who do not quite have the courage to kill themselves • Engage police in threatening manner • Getting themselves shot • The cops complete the suicide 12

13. CIT TRAINING • Has helped many police become more caring crisis workers 13

14. TRANSCRISIS IN LONG-TERM THERAPY • Behavior Regression to pre-therapeutic functioning • Anxiety (Cognitive irrationality, Fear of failure) • Suggestions: deep-breathing, role play, review of other successes, support system, security net • Regression (maladaptive but familiar ways of behaving, feeling, thinking) • Suggestions: Interpreting, reality based confrontation 14

15. TRANSCRISIS - LONG-TERM THERAPY (CONT) • Problems of Termination • Dependency issues • Preparation may be needed • Crisis in Session (opening can of worms?) • Stay in control to model appropriate behaviors • Psychotic Breaks • Delusional or dissociative break with reality • Client name, keep client in reality, repeat requests 15

16. TRANSCRISIS - LONG-TERM THERAPY (CONT) • Manipulative clients (avoiding engagement in new behaviors) • Testing the counselors credibility • Borderline Personality Disorder • Set clear limits, empathic support, caring confrontation, stick to principles • Professional detachment and keeping cool • Counselor refusing to be ‘used’ and ‘doing all of the work’ 16

17. DIFFICULT CLIENTS • May need set of Printed Rules (Ex: p. 111) • Confront behavior directly (assertive and directive) • Termination • Consultation with other professionals 17

18. CONFIDENTIALITY IN CASE HANDLING The limits of confidentiality and privileged communication come under scrutiny when a case involves the potential for violent behavior. • Legal Principles (limited for counselors) • Ethical Principles (code of professional conduct) • Moral Principles (personal and may be in opposition to ethical codes and legal statuetes) 18

19. DUTY TO WARN • Convey to client early on • Liability insurance • document • If unsure: • Consult with other professionals • Victim identity?, Motive?, Means?, Plan? • Client is out of control • Doesn’t understand what he or she is contemplating • Incapable of collaboration 19

20. DUTY TO WARN • If client is concretely stating a threat – warn authorities • Invite client to participate • Surrender weapons • Inform those who need to know • Check State statutes. 20