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How to Recognize a Mental Health Crisis and Intervene

Carrier Clinic’s Webinar Series

On May 31st, Carrier Clinic’s® Psychiatric Acute Care Unit Director, Jacqueline Bienenstock, DNP, RN-BC, hosted a webinar on“How to Recognize a Mental Health Crisis and Intervene.” This post provides a breakdown of the information discussed during the webinar. Skip down to read that information. We are also sharing the video and audio recordings that you may watch/download if interested.

If you or someone you know is in crisis and in need of immediate help, call 911, go to the closest emergency room, or call Carrier Clinic’s 24-hour-a-day, 7-days-a-week Access Center at 1-800-933-3579.

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Definition of Mental Illness in Adults

Mental Health Disorder is a diagnosable illness that affects a person’s thinking, emotional state, and behavior, and the ability to relate to others. Just as diabetes is a disorder of the pancreas; mental illness is a disorder of the brain that can make it difficult to cope with the demands of life, disrupting the person’s capability to work, carry out daily activities, and engage in satisfying relationships.

One out of five adults experiences mental illness in a given year. Yet, only 41 percent of people with a mental health illness use mental health services within a given year. In addition, some experience a substance use condition along with their co-occurring mental illness. Mental Health costs the United States 193.2 Billion in lost earnings per year.

Common Mental Health Disorders:

  • Depressive Disorders
  • Bipolar Disorders
  • Schizophrenia
  • Anxiety Disorders

Diagnosis is based on clinical observations of behavior in the person and reports from others close to them. However, symptoms vary from one person to the other and each person responds differently which then complicates getting an accurate diagnosis.

What is a Mental Health Crisis?

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.

Many things can lead to a mental health crisis and examples of situations that can lead or contribute to a crisis include:

  • Home or environmental stressors
  • School/work stressors
  • Using or abusing drugs/alcohol
  • Starting new medication or new dosage of current medication
  • Stopping medication or missing doses
  • Treatment stops working

Anyone that may be going through a mental health crisis may experience guilt, anger, or grief. It is important to address a mental health emergency quickly and effectively. Some individuals who are dealing with a mental health illness may not exhibit any warning signs. Please remember no one is to blame, not the person or the family.

Warning Signs of a Mental Health Crisis

It is important to know and recognize the warning signs that an individual may be struggling with so that you can support them in the best way possible.

According to NAMI (National Alliance on Mental Illness), these are the most common warning signs:

  • Inability to perform daily tasks, bathing, getting dressed, etc.
  • Rapid mood swings
  • Increased agitation, risk-taking/out of control behavior
  • Abusive behavior to self or someone else
  • Isolation from school, work, family, and friends
  • Loss of touch with reality
  • Paranoia

When the Crisis Involves the Risk of Suicide

Risk of suicide is a major concern for anyone with a mental health condition and those who love them. Encouraging someone to get help is the first step towards safety.

People who attempt suicide usually feel:

  • overwhelming emotional pain, loneliness, worthlessness, hopelessness, powerlessness, frustration, shame, guilt, rage, and sometimes self-hatred.

Social isolation is very common in the lives of those with mental illness because it reinforces the belief that no one cares if they live or die.

Any talk of suicide MUST always be taken seriously. If someone has attempted suicide before the risk is even greater.

Warning Signs of Suicide

According to NAMI, the following are the warning signs of suicide:

  • Giving away personal possessions
  • Talking as if saying goodbye
  • Stockpiling pills or obtaining a weapon
  • Taking steps to tie up loose ends
  • Making or changing a will
  • Preoccupation with death
  • Sudden cheerfulness or calm after being despondent
  • Increased drug or alcohol use
  • Dramatic changes in personality, mood, and/or behavior
  • Saying things like: “Nothing matters anymore.”, “You’ll be better off without me.”,  and “Life isn’t worth living.”
  • Withdrawal from friends, family, and regular activities/interests
  • Failed romantic relationships
  • History of suicide attempts or family or friend suicide attempts

What to Do if You Suspect Someone is Thinking About Suicide

If you notice any of the above warning signs or if you are concerned someone you know is thinking about suicide you must start the conversation.

How to Talk to Someone at Risk of Suicide

Open the conversation by sharing specific signs you noticed. For example:

  • “I have noticed lately that you have not been sleeping, you are not interested in basketball anymore which you used to love, you are posting a lot of sad songs online.”

The next question should establish if they are thinking about or planning for suicide. This can be along the lines of:

  • “Are you thinking about suicide?”, “Do you have a plan?”, “Do you know how you would do it?”, “When was the last time you thought about suicide?”

If the answer is yes or if you think they might be at risk of suicide you must seek help immediately.

  • Call a healthcare professional who has been working with the person, preferably their therapist or psychiatrist/physician if they have one. (It is a good idea to obtain this person’s contact information in advance so you have it on hand quickly if ever needed.)
  • Remove things like weapons and medications.
  • Call 911 or the National Suicide Prevention Line 1-800-273-8255.
  • Listen, offer support and assurance, focus on being understanding, caring, and nonjudgmental. For example:
    • “You are not alone”, “I’m here for you”, “You are important to me, we will get through this together”, “I am concerned about you and I want you to know there is help available to get you through this.”

NAMI – Navigating a Mental Health Crisis

What NOT to Say or Do if You Suspect Someone is Thinking About Suicide

  • Do not promise secrecy. Instead, you can say something like, “I care about you too much to keep this kind of secret.”, “You need help, and I’m here to help you get it.”
  • Do not debate the value of living or argue that suicide is right or wrong.
  • Do not ask a question that indicates you want ‘no’ for an answer. For example: “You’re not thinking about suicide are you?”
  • Do not try to single-handedly resolve the situation.
  • NEVER say “it’s all in your head, just snap out of it.”
  • Please remember a suicide threat or attempt is a medical emergency requiring professional help as soon as possible. Call 911 and get help.

NAMI – Know the Signs

Techniques that May Help De-escalate a Crisis

Keep these important techniques in mind in the event of a crisis. Remember that you are there to listen, be supportive, and get the person the help they need. Do you’re best to remain calm, and let them know that you are there for them and they are not being judged.

  • Keep your voice calm
  • Avoid overreacting
  • Listen to the person
  • Express support and concern
  • Avoid continuous eye contact
  • Ask how you can help
  • Move slowly
  • Offer options instead of trying to take control
  • Be patient
  • Avoid touching the person unless you ask permission
  • 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

NAMI – Navigating a Mental Health Crisis

If you cannot de-escalate the crisis yourself you can seek additional help from mental health professionals who can assess the situation and determine the level of crisis intervention required.

Types of Treatment

Now that you know what to do in a crisis, the next step is treatment. Treatment can take place in two types of settings: Inpatient or Outpatient.

Inpatient Treatment

Inpatient means the person is admitted to a treatment environment that requires staying overnight. It may be a hospital, a residential treatment center, or a crisis unit, but the treatment is provided while the person is on site at the treatment facility 24 hours a day.
The length of stay in an inpatient setting varies and usually depends on the severity of the crisis as well as health insurance coverage.

Outpatient Treatment

Outpatient means mental health services are provided while the person lives at home and continues their regular routine with work, school and family life. This treatment is considered the least restrictive form of treatment.

Types of Health Care Professionals Involved in Mental Health Care Treatment

Throughout the treatment process, the treatment team may be made up of several of the below types of healthcare professionals. Here is an overview of what each type is responsible for.

Psychiatrists

Medical doctors who specialize in psychiatry and are typically in charge of the patients care plan.

Psychologists

Administer diagnostic tests, conduct individual, family, or group therapy sessions

Psychiatric Nurse Practitioners

Diagnose and treat mental health conditions and provide health care including prescribing medication.

Registered Nurses

Assess the patient’s progress and provide emotional support encouragement and health education. The RN also administers medications and monitors the overall health of the patient.

Therapists

Conduct individual, group, or family therapy. The therapist can be a psychologist, a licensed clinical social worker, lessened professional counselor, and marriage and family counselor.

Social Workers

Identify social service and therapeutic needs, help connect the patient with community resources and make referrals for services. They work directly with the patient, their family and community providers to explain treatment options and plans and identify any ongoing needs of the patient.

Nursing Assistant/Psychiatric Aid/Mental Health Worker/Behavior Technicians

They work under the direction of Psychiatrists and nurses in inpatient settings to provide routine nursing and personal care for the patient including eating, dressing, grooming, and showering. They help ensure the unit is safe.

Case Managers

They assist with applying for resources such as social security benefits and Medicaid. They are aware of housing options in their area and know how to get housing vouchers or rental assistance. They know about community programs and groups, and about job training and possible work.

Patient Advocates

Assists families to resolve or address issues regarding quality, appropriateness, and coordination of care for the patient.

Following a Crisis

A critical part of the discharge plan is an appointment with a mental health professional; typically within 7 days of being discharged. These appointments should be made before leaving the facility where crisis services were received.

To assist the mental health professional at the follow-up appointment you will need the following information:

  • Name of all medications-purpose of medication, dosage, side effects experienced
  • Any changes in living situation
  • Access to transportation
  • If the crisis plan continues to meet your loved one’s needs
  • How other medical conditions are being managed

It is important to remember that crisis services are meant to help those who are mentally ill get the help they need in a safe setting. Recovery can be a process that requires ongoing care, treatment, and support.

Mental Health First Aid History

In the medical field we talk about CPR saving lives; in the psychiatric field and the addiction world, Mental Health First aid is equal to CPR.

-Jacqueline Beinenstock, Psychiatric Acute Care Unit Director

Mental Health First Aid began in 2001 in Australia and came to the United States in 2008. This is an evidence-based program that has proven to have positive program outcomes.

The most important thing to remember is to always see the person first and not reduce a person to a list of symptoms or diagnosis.

Culture plays a significant role in how warning signs may manifest and in what types of interaction treatment and supports may be helpful.

Mental Health First Aid is an 8-hour course that teaches participants how to recognize the symptoms of mental health problems, how to offer and provide initial help and how to guide the individual to professional help if appropriate.

Mental Health First Aid is equivalent to a First Aid training course. It does not teach you to be the professional, the therapist, or the counselor. It reviews your role and limitations of being a mental health first aider.

The goal of Mental Health First Aid is to demystify the topic of mental illness and to increase the awareness and importance of mental health and to decrease the stigma.

5 Steps for Mental Health First Aid

You can help in a crisis situation by following the ALGEE action plan:

A– Assess for risk of suicide or harm
L– Listen non-judgmentally
G-Give reassurance and information
E-Encourage appropriate professional help
E-Encourage self-help and other support strategies

What is a Safety Plan and the Importance of Having One

  • Step 1 – Warning signs that a crisis may be developing
  • Step 2 – Internal coping strategies, things I can do to take my mind off my problems without contacting another person (relaxation technique-physical activity)
  • Step 3 – People and social settings that provide distraction.
  • Step 4 – People whom I can ask for help.
  • Step 5 – Professionals or agencies I can contact during a crisis. (Therapist, emergency contact, AA, NA, PACT team worker)
  • Step 6 – Making the environment safe.

Resources for Mental Health Crisis Concerns

National Suicide Prevention Lifeline (24/7): 1-800-273-TALK
Somerset County Mental Health Crisis Team (24/7): 908-526-4100

Somerset County Behavioral Resources

Alcoholics Anonymous of Northern NJ 800-245-1377
Al-Anon – English 973-744-8686
– Spanish 973-268-1260
Atlantic Behavioral Health 888-247-1400
Bonnie Brae School & Residential Treatment Center (males ages 12-18) 908-647-0800
Carrier Clinic 800-933-3579
Crawford House (Daytop New Jersey at Crawford House) 908-874-5153
Daytop Village 973-543-5656
Easter Seals 732-257-6662
Eating Disorders (ED) Program by RWJUH-Somerset 800-914-9444
GenPsych 855-436-7792
High Focus Centers 732-474-7447
Hunterdon Behavioral Health 866-424-2060
JFK Center for Behavioral Health 732-321-7189
Narcotics Anonymous NJ 732-933-0462
National Awareness on Mental Illness NJ (NAMI-Somerset Chapter) 732-940-0991
New Jersey Addiction Services Hotline 844-276-2777
Richard Hall Community Mental Health (908) 725-2800
Seabrook House 800-761-7575
Sexual Assault 24-hr Hotline by Zufall Health Center in Somerville 908-526-7444
SHIP (Samaritan Homeless Interim Program) 908-393-9545
Robert Wood Johnson University Hospital – Somerset Behavioral Health 800-914-9444
University Behavioral Healthcare 800-969-5300
Vet to Vet Hotline 866-838-7654

More Support

For a longer list of crisis centers and support groups and their phone numbers and websites, please check our Helpful Resources page.

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Whattodo

If a family member or friend is struggling with addiction or mental health issues, and it’s not necessarily a crisis situation, but you still need guidance in what to do, visit out Whattodo resource.

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