Crisis Resolution & Home Treatment Teams
Listening to practitioners, and placing the resources where they can make a real impact.
Defining 'Crisis' & 'Emergency'
Based on discussions from two workshops with the Great Yarmouth & Waveney Home Treatment Team
- Tensions frequently arise between clinical teams, based on the real or perceived lack of clarity in defining what a crisis is, and the different interpretations of the term. Differences may arise within and between teams, through issues of definition and 'thresholds of tolerance' of a crisis situation between people (inc. practitioners).
- At the broadest level, the definition of a crisis lies in the eye of the beholder - if a person asking for help says the situation is a crisis, then it is a crisis.
- However, this definition is not very helpful for supporting a Home Treatment Team to focus its resources, as G.P.'s could potentially refer anyone in 'distress'.
- For the purpose of a mental health Home Treatment Team the potential population can be narrowed by introducing a medical screening element through the need for a 'psychiatric diagnosis'; and refined further by specifying elements of 'risk'.
- However, the degree of serious imminent risk may also result in the situation being defined as a psychological emergency, for which emergency services not the Home Treatment Team are most appropriate.
- At the point of referral, it is important to help referrers differentiate between a crisis and an emergency, to help identify the most immediate and appropriate response. A large majority, but not all emergencies occur in the context of a crisis.
- Home Treatment Team's may work with emergency situations within the longer context of a period of crisis intervention, but they are not the most appropriate first line of response in a sudden emergency.
Psychological Emergency
A relatively abrupt, sudden situation in which there is an imminent risk of harm. Such circumstances are limited, and include only four situations:
- Risk of suicide.
- Risk of physical harm to others.
- States of seriously impaired judgement in which an individual is endangered (delirium, dementia, acute psychotic episode).
- Situations of risk to a defenceless victim (abused child or elder who remains in the custody of the perpetrator).
It is an unpredictable, acute situation that requires an immediate response to avoid possible harm. The most usual intervention is to call the designated emergency services (999).
Psychological Crisis
A serious disruption of the individual's baseline level of functioning, such that his or her usual coping mechanisms are inadequate to restore equilibrium. It is an emotionally significant event in which there may be a turning point for better or worse. It is generally non-specific, longer-lasting than an emergency, and does not necessarily imply danger or serious physical harm or life-threatening danger. At such time, an individual's normal coping responses are insufficient to resolve the situation, resulting in a marked increase of anxiety, tension and agitation, or depression and defeat. A crisis may often be a self-limiting period of a few days to 6 weeks, in which environmental stress leads to a state of psychological disequilibrium. Referral to a Home Treatment Team is the most appropriate course of action.
"The situation may not necessarily be defined as a crisis where it is a chronically on-going chaotic pattern, where there are fluctuations of circumstance but no real change in the long-term pattern of events".
Definitions based on: Kleespies, P.M. (ed.) (1998) Emergencies in Mental Health Practice: Evaluation and Management. New York, The Guilford Press.