In 2012 a man in Pittsburgh felt rejected when a hospital would not admit him. Due to hallucinations he was experiencing and withdrawal from an illegal substance, he believed he was in imminent danger. His crisis turned into a tragedy when he opened fire the next day, killing several people and wounding others.
This and other violent events stay with me, as a mental health professional, and remind me that what starts as a smaller crisis can escalate into something much bigger. Moments such as this require that there are bystanders, mental health professionals, doctors, and staff members who are knowledgeable about crises and how to de-escalate the person and those around them. Many of us are taught to back away from arguing with or challenging a person who is in crisis and to take a compassionate position. But the sad reality is that many people never fully develop the skills necessary to intervene. And not having the appropriate knowledge can be deadly.
In the fourth edition of Crisis Intervention Handbook: Assessment, Treatment, and Research, editors Kenneth Yeager and Albert Roberts describe the protocol that can help us in potentially dangerous situations. We must assess lethality, they write, meaning we must find out if the person has access to weapons or pills to harm themselves or others. We must establish rapport and communication — find some way to relate to the person and build trust with them in a short period of time. We must figure out what sent the person into crisis mode, provide an outlet for them to vent or talk about how they feel, explore ways that the person can avoid crisis mode in the future, formulate an action plan, and follow up.
These seven steps, the book explains, are extremely important — and they seem especially vital for those of us who work in the mental health field and interact with individuals who are struggling.
The case studies in the book are useful, showing us how intervention techniques should be used, and when. And, since different situations require different approaches, the editors discuss specific techniques for people such as battered women, stalking victims, substance abusers, individuals who require mobile crisis services, and HIV-positive clients.
One example is of a suicidal and escalated teenager who has barricaded herself in her bedroom and has a history of suicide attempts. Yeager and Roberts contrast this example with another: someone who is struggling with withdrawal symptoms and yet does not seem to be in imminent risk and may not need mobile intervention services if someone can provide support to her over the phone.
The book, at 840 pages, is comprehensive when it comes to trauma-informed care and crisis intervention. It can be somewhat dry, but provides a wonderful foundation for safe and ethical practice in all clinical settings.
Crisis Intervention Handbook: Assessment, Treatment, and Research (4th Edition)
Oxford University Press, May 2015
Hardcover, 840 pages