Section 12: Crisis Intervention

1. Section 12: Crisis Intervention UCLA

2. Give me some examples • Form groups of 4-6. • Agree on 3 examples of crises faced by your staff • What made these crises challenging to deal with?

3. Things to Consider When Facing a Crisis

4. Things to Consider… • Are you safe? • Are other clients safe? • Is the client in crisis safe? • Can I handle this? • What other resources do I need? • How do I feel better after it’s over?

5. Are you safe? • Protecting your safety is protecting the safety of the client • If they hurt you • They will no longer feel safe, • They will no longer be able to receive treatment from your agency • Putting your safety first is in the best interest of the client.

6. Keeping yourself safe… • The Office Setup • Be conscious of where you are in the office

7. Counselor Client Counselor Client

8. Keeping yourself safe… • The Office Setup • Be conscious of where you are in the office • Be aware of ways of asking for help

9. Keeping yourself safe… • Personal Style • Be careful not to reflect negative emotional states • Watch your body language • Stay calm and keep you voice tone low and soft • Be careful not to stand over or lean into patient

10. Keeping yourself safe… • If none of that works… • Get out • Take a break • Leave the office • Leave the building • Get help • Call a supervisor • Call a colleague • Call the police

11. Things to Consider… • Are you safe? • Are other clients safe? • Is the client in crisis safe? • Can I handle this? • What other resources do I need? • How do I feel better after it’s over?

12. Are other clients safe? • Where is the crisis happening? • If other clients are observing, they may not feel safe • We do not want to contribute to the chaos of their lives • They want to have confidence in their environment. • A crisis with one client may lead to a crisis with another

13. Keeping other clients safe… • Calm the participant (and you) • Protect confidentiality • Protect other clients from direct harm • Protect other clients from “helping” • Remove the situation to a quiet, safe place. This will help to:

14. Things to Consider… • Are you safe? • Are other clients safe? • Is the client in crisis safe? • Can I handle this? • What other resources do I need? • How do I feel better after it’s over?

15. Is the client in crisis safe? • Is the Client a danger to: • Self? • Others? If danger = being aggressive, follow recommendations above If danger = killing self or others, follow recommendations above AND make sure they get assessed.

16. What is a Suicide/Homicide Assessment? • If you think that someone wants to kill him/herself or someone else, they must be evaluated. • If risk is significant, they may need to be hospitalized • If risk is minimal, a plan needs to be developed in case feelings get worse.

17. Risk factors • Common psychiatric risk factor leading to suicide • Depression* • Major Depression • Bipolar Depression • Alcohol and Drug abuse and dependence • Schizophrenia • Other psychiatric risk factors with potential to result in suicide • Post Traumatic Stress Disorder (PTSD) • Eating disorders

18. Risk factors for Suicide Symptom Risk Factors During Depressive Episode • Desperation • Hopelessness • Anxiety/psychic anxiety/panic attacks • Sudden change in mood • Aggressive or impulsive personality • Has made preparations for a potentially serious suicide attempt or has rehearsed a plan during a previous episode • Recent hospitalization for depression • Psychotic symptoms

19. Risk factors • Major physical illness-especially recent • Chronic physical pain • History of trauma, abuse, or being bullied • Family history of death by suicide • Drinking/Drug use • Being a smoker

20. Symptoms and Danger SignsWarning Signs of Suicide Danger • Talking about suicide. • Statements about hopelessness, helplessness, or worthlessness. • Preoccupation with death. • Suddenly happier, calmer. • Loss of interest in things one cares about. • Visiting or calling people one cares about. • Making arrangements; setting one's affairs in order. • Giving things away, such as prized possessions.

21. Symptoms and Danger SignsWarning Signs of Suicide Warning Signs • Observable signs of serious depression • Unrelenting low mood • Hopelessness • Anxiety • Withdrawal • Sleep problems • Increased alcohol and/or other drug use • Recent impulsiveness and taking unnecessary risks • Threatening suicide or expressing strong wish to die • Making a plan (giving away possessions, obtaining other means of killing oneself) • Unexpected rage or anger

22. Assessment of Suicide • History • Influences • Lethality • Psychological Organization • Evaluation of Risk Potential • Recommendations

23. Crisis Intervention: CASE STUDIES The following two case study exercises present crisis scenarios. Please break out into groups of 2-4 and carefully read each scenario, then write down your response as counselor. You will then share your responses to the class.

24. Exercise 1Case Study 1: Farida • Farida is a 25-year old Ritalin and Valium addict with 3 months of sobriety, whom you have been seeing once a week. When she walks into your clinic today, she appears forlorn and acts withdrawn. She refuses to answer your open-ended and closed-ended questions. Finally, she mutters, “My husband is seeing another woman and he told me he is leaving me. Without him, my life isn’t worth living anymore. I just want to go to sleep and not wake up.”  What do you do?

25. Exercise 2Case Study 2: Mariam • Mariam is a 32-year old heroin addict who comes to your clinic for a scheduled appointment. She has not used drugs for 1 month. Today she seems uncharacteristically happy and in a calm, almost content state. You know she has tried to commit suicide 3 times in her past.  When you ask her if she has had any thoughts of suicide lately, she responds, “Oh, I don’t know…maybe once or twice. No big deal.” Describe your next steps.