Crisis Intervention

Article Author:
David Wang
Article Editor:
Vikas Gupta
Updated:
7/2/2020 9:10:15 AM
PubMed Link:
Crisis Intervention

Definition/Introduction

Crisis intervention is a short-term management technique designed to reduce potential permanent damage to an individual affected by a crisis. A crisis is defined as an overwhelming event, which can include divorce, violence, the passing of a loved one, or the discovery of a serious illness. A successful intervention involves obtaining background information on the patient, establishing a positive relationship, discussing the events, and providing emotional support. SAFER-R is a common intervention model used, which consists of stabilization, acknowledgment, facilitate understanding, encouragement, recovery, and referral. SAFER-R helps patients return to their mental baseline following a crisis.

It can be used in conjunction with the Assessment Crisis Intervention Trauma Treatment (ACT), which is a seven-stage crisis intervention model. It consists of assessing the affected person, establishing a relationship, understanding the problem, confronting emotions, exploring coping strategies, implementing a plan, and following up. Utilization of these methods can help restore one’s mental state and prevent any psychological trauma immediately following a crisis. Crisis intervention has also been developed as a possible treatment plan for those with severe mental illnesses.[1] In this review, we will discuss major concerns, clinical aspects, and what healthcare professionals can do to improve techniques for crisis intervention. 

Issues of Concern

People affected by a crisis can potentially harm themselves and others, which is a significant concern as to why crisis intervention is needed. It mitigates those risks. For example, family members of a patient in a vegetative state reported having high levels of stress and anxiety that negatively impacts their own physical and mental health [2]. In December of 2019, COVID-19 caused many deaths and widespread panic, which brought severe psychological distress to many people. In response to this crisis, psychological counseling teams in China were dispatched to provide services to dampen the psychological aftershock felt by both medical professionals and patients.[3] 

In these cases, psychological crisis intervention is necessary to prevent traumatized victims from developing illnesses. It also alleviates stress upon healthcare workers so that they can continue helping others. Another major concern is what coping strategies are most effective. Social support and problem-solving planning are effective coping mechanisms that are frequently used by school staff following a crisis.[4] The use of humor, emotional support, planning, and acceptance also correlate with superior mental health outcomes compared to substance abuse and denial.[5] Positive coping mechanisms, such as the ones listed above, are reported to be effective in crisis management, and with crisis intervention services in place, people will be better equipped to handle unexpected events.  

Clinical Significance

If left unmanaged, a person with a severe crisis can undergo a significant amount of psychological stress, which carries links to major depressive disorder and other mental health conditions.[6] Not only is crisis intervention effective in preventing the development of mental illness, but it can also be used in a clinical setting to treat patients currently suffering from one. Emergency departments with crisis intervention teams for adult and pediatric patients revealed reasonable reductions in return visits and duration of stay.[7] Also, crisis care reduced the number of repeat admissions to the hospital and is more effective than standard care at improving the mental state of a patient.[1] 

Based on prior studies, it is evident that crisis intervention plays a significant role in enhancing outcomes in psychiatric cases. Community Mental Health Centers and local government agencies often have crisis intervention teams that provide support to the local community at times of mental health crisis. These teams can also be helpful at times of natural or man-made emergencies. Crisis intervention teams often assess and triage the situation and can diffuse the situation and triage for urgent attention of medical or mental health personnel in emergency or community care settings. They can call upon local police and other community resources for additional support.

When situations are less urgent, the crisis teams can provide useful resources in the community setting to affected individuals. Crisis intervention plays a significant role to appropriately address crisis scenarios and triaging serious events that need more urgent care besides diffusing situations and providing resources to individuals in need.

Nursing, Allied Health, and Interprofessional Team Interventions

There are many approaches to integrating crisis intervention, and a member of the healthcare team can complete each step. First responders can triage and assess the situation and administer psychological first aid as needed to victims of a traumatic event to prevent any long-term mental health problems.[8] 

This approach allows immediate access to crisis intervention, which will facilitate care and lead to improved outcomes. In a hospital setting, the needs of a patient in crisis should be well communicated throughout the management team. As one study suggests, in times of crisis intervention, health professionals should discuss in advance and agree on a plan of care to better facilitate the recovery of the patient.[9] 

Nurses are also crucial to crisis management teams as they are at the forefront of patient care. They can notice declining mental health and promptly distribute crisis intervention resources. Crisis intervention is a technique that should be available to all healthcare professionals and requires productive communication to be an effective use of care. 

Nursing, Allied Health, and Interprofessional Team Monitoring

Patients receiving crisis management treatment should be closely monitored by the healthcare team to ensure optimal recovery. Careful monitoring can also reveal the most efficient method of crisis intervention. Healthcare providers can utilize a treatment progress indicator to track a patient’s progress and reduce the need for any additional treatment. A treatment progress indicator assesses the severity of a patient’s mental condition and can monitor the effectiveness of therapy over time. It has been consistently reliable for patients with depression and anxiety.[10] This type of monitoring will allow clinicians to create or modify crisis intervention techniques to serve the needs of the patient best. 


References

[1] Murphy S,Irving CB,Adams CE,Driver R, Crisis intervention for people with severe mental illnesses. The Cochrane database of systematic reviews. 2012 May 16;     [PubMed PMID: 22592673]
[2] Li YH,Xu ZP, Psychological crisis intervention for the family members of patients in a vegetative state. Clinics (Sao Paulo, Brazil). 2012;     [PubMed PMID: 22522759]
[3] Jiang X,Deng L,Zhu Y,Ji H,Tao L,Liu L,Yang D,Ji W, Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. Psychiatry research. 2020 Feb 28;     [PubMed PMID: 32146245]
[4] Cole R,Hayes B,Jones D,Shah S, Coping Strategies Used by School Staff After a Crisis: A Research Note. Journal of loss     [PubMed PMID: 25170309]
[5] Saxon L,Makhashvili N,Chikovani I,Seguin M,McKee M,Patel V,Bisson J,Roberts B, Coping strategies and mental health outcomes of conflict-affected persons in the Republic of Georgia. Epidemiology and psychiatric sciences. 2017 Jun;     [PubMed PMID: 26804972]
[6] Yang L,Zhao Y,Wang Y,Liu L,Zhang X,Li B,Cui R, The Effects of Psychological Stress on Depression. Current neuropharmacology. 2015;     [PubMed PMID: 26412069]
[7] Hamm MP,Osmond M,Curran J,Scott S,Ali S,Hartling L,Gokiert R,Cappelli M,Hnatko G,Newton AS, A systematic review of crisis interventions used in the emergency department: recommendations for pediatric care and research. Pediatric emergency care. 2010 Dec;     [PubMed PMID: 21131813]
[8] Birkhead GS,Vermeulen K, Sustainability of Psychological First Aid Training for the Disaster Response Workforce. American journal of public health. 2018 Nov;     [PubMed PMID: 30260696]
[9] Lester H,Tritter JQ,Sorohan H, Managing crisis: the role of primary care for people with serious mental illness. Family medicine. 2004 Jan;     [PubMed PMID: 14710326]
[10] Tuso P, Treatment progress indicator: application of a new assessment tool to objectively monitor the therapeutic progress of patients with depression, anxiety, or behavioral health impairment. The Permanente journal. 2014 Summer;     [PubMed PMID: 24937147]