Crisis intervention strategies chapter 5

CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC 1... CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC CONT 2.. CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC CONT 3.. CASE HANDLING AT CO

Chapter 5 – Crisis Case Handling

LONG TERM CASES CRISIS CASES

1 Broader in Scope

2 Methodological treatment

3 Continuous feedback

4 Leisurely/weekly

5 More background info.

6 More psycho-educational

7 Seeking to change

residual, repressive and

chronic modes of thinking,

feeling and acting

8 Personality change

1 Compressed scope

2 Best guess or set

procedures

3 Here and now

4 Minutes/hours

5 Specific crisis info

6 Quick determination of

coping skills, resources,

7 Movement to stability

8 Restoration of functioning

See Tables 5.1, 5.2, 5.3, 5.4

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WALK-IN’S - TYPES OF PRESENTING CRISES

1 Chronic Mental Illness (often multiple problems with inconsistent care)

2 Acute Interpersonal Problems in Social

Environment (runaways, crime victims, violent

events, unemployed, etc.)

3 Combination of the two (fairly common)

Note: Often with financial problems prohibiting

private care

CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC

1. Entry

• Disposition of the case

• Possible isolation

• Case history

• Thinking processes

• Threats to self or others

• Drug abuse

• Psychiatrist may be needed

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CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)

2. Commitment to inpatient facility may be

needed

• Voluntary

• Involuntary (physician orders/evaluation and

crisis trained transportation)

CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)

3. (If Coherent) Intake Interview

• Written and verbal

• Define the problem

• Assess for client safety

• Apprise the client of rights

• Usually standardized intake sheet

• Degree of lethality and drug use

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CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)

4. Disposition

• proposed diagnosis

• treatment recommendations

• Discuss with client

• Client chooses to accept or reject

• Next steps/therapists/clinical team meeting

CASE HANDLING AT COMMUNITY MENTAL HEALTH

CLINIC (CONT)

5. Anchoring

• Never left alone

• Gain feeling of care and support

• Structured/methodical orientation

• Establishing rapport, support, encouragement,

sense of security

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CASE HANDLING AT COMMUNITY MENTAL HEALTH

CLINIC (CONT)

6. Short-term Disposition (basic physical

needs)

7. Long-term disposition (psychiatric or

pharmacological evaluation)

• With objectives, goals, and therapeutic plan and

regular review of plan

8. 24 hour telephone service/hotline

• Evaluating and referring

CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)

9. Mobile Crisis Teams/Police

• When client is out of control and unwilling or

unable to go to the clinic

• Jail is frequent

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CRISIS INTERVENTION TEAM (CIT)

• Train Patrol officers to deal with the mentally

ill and emotionally disturbed

• Utilizing Mental Heath Experts and Providers

• Including relationships with other community

and medical resources

• De-escalation and diffusing techniques

• Fishbowls (Trainees observe discussions with

SUICIDE BY COP

• People who do not quite have the courage to

kill themselves

• Engage police in threatening manner

• Getting themselves shot

• The cops complete the suicide

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CIT TRAINING

• Has helped many police become more caring

crisis workers

TRANSCRISIS IN LONG-TERM THERAPY

• Behavior Regression to pre-therapeutic

functioning

• Anxiety (Cognitive irrationality, Fear of failure)

• Suggestions: deep-breathing, role play, review of other successes, support system, security net

• Regression (maladaptive but familiar ways of

behaving, feeling, thinking)

• Suggestions: Interpreting, reality based

confrontation

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TRANSCRISIS - LONG-TERM THERAPY (CONT)

• Problems of Termination

• Dependency issues

• Preparation may be needed

• Crisis in Session (opening can of worms?)

• Stay in control to model appropriate behaviors

• Psychotic Breaks

• Delusional or dissociative break with reality

TRANSCRISIS - LONG-TERM THERAPY (CONT)

• Manipulative clients (avoiding engagement in new

behaviors)

• Testing the counselors credibility

• Borderline Personality Disorder

confrontation, stick to principles

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DIFFICULT CLIENTS

• May need set of Printed Rules (Ex: p 111)

• Confront behavior directly (assertive and

directive)

• Termination

• Consultation with other professionals

CONFIDENTIALITY IN CASE HANDLING

The limits of confidentiality and privileged

communication come under scrutiny when a

case involves the potential for violent behavior

• Legal Principles (limited for counselors)

• Ethical Principles (code of professional

conduct)

• Moral Principles (personal and may be in

opposition to ethical codes and legal statutes)

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DUTY TO WARN

• Convey to client early on

• Liability insurance

• document

• If unsure:

DUTY TO WARN

• If client is concretely stating a threat – warn

authorities

• Invite client to participate

• Surrender weapons

• Inform those who need to know

• Check State statutes

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