What is a mental health crisis?

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As a psychiatric NP, I treat patients with mental illness through medication and therapy, but there are no guarantees treatment will work. It’s often a process to find a medication that both works to control the patient’s symptoms and doesn’t cause the unwanted side effects (such as sedation and weight gain) that can make a patient not want to continue taking it.

While this process is happening, the patient is living his or her life, coping with usual stressors such as working and navigating personal relationships, and possibly more intense stressors like poor living conditions or trauma. These factors can put someone at risk for a mental health crisis.

According to the National Alliance on Mental Illness (NAMI), “a mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community.” When a person exhibits these types of behaviors, it’s common for 911 to be called and for police officers to arrive on the scene. This can have dangerous ramifications for the person with mental illness. However, there is hope on the horizon.

Expanding the options for responding to a mental health crisis.

This month’s AJN Reports by Dalia Sofer looks at trends in the response to mental health emergencies. Sofer reports:

“Increasingly, in an effort to diminish the frequency of violent and fatal encounters, police departments have been instituting crisis intervention training programs to better train officers to engage with people who have mental illness, often in collaboration with mental health professionals and other service providers.”

Partnering with the police to respond to mental health emergencies.

One such program was developed by Jeanine Loucks, MSN, RN-BC, PMH, who was featured in our  Profiles column in 2016. This two-day program provides police departments with information on mental illness, including diagnoses, how to better communicate with potential patients in the field, and de-escalation practices.

In addition to this training, there are now programs around the country where a 911 call is responded to by teams of mental health experts. The team provides support, helps stabilize patients, and can give referrals for treatment. In these situations, police are only called in if deemed necessary.

De-escalation strategies.

There is still a lot of work to do and a pressing need to reduce mental illness stigma and provide adequate services prior to a crisis. If you come across someone experiencing a mental health crisis in practice or even when you are out in the community, below are some de-escalation strategies recommended by NAMI:

  • Keep your voice calm
  • Avoid overreacting
  • Listen to the person
  • Express support and concern
  • Avoid continuous eye contact
  • Ask how you can help
  • Keep stimulation level low
  • Move slowly
  • Offer options instead of trying to take control
  • Avoid touching the person unless you ask permission
  • Be patient
  • Gently announce actions before initiating them
  • Give them space; don’t make them feel trapped
  • DON’T make judgmental comments
  • DON’T argue or try to reason with the person

Christine Moffa, PhD, APRN, PMHNP-BC, is AJN’s​ senior clinical editor