Many things can lead to a mental health crisis, and anyone can experience one. Because mental health and substance use disorder are closely tied, a mental health crisis is something people in recovery can experience at a disproportionate rate. As a Peer Provider, it’s important to understand the importance of crisis intervention. We understand that crises can look different from one person to the next, we wanted to provide more context around what to look out for when identifying a crisis. In this post, we’ll define what a crisis is, and some signs that can indicate someone may be experiencing one. We’ll also offer some examples of behavioral shifts that can indicate this, as well as interventions to take when a client experiences a crisis scenario.

 

What is a “Crisis” in Behavioral Health?

A crisis, or mental health crisis, can be defined as 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 (NAMI). 

 

It’s important to note that a crisis may look different for everyone. It’s critical to look at what is typical of your client’s behavior, and assess whether certain behaviors/factors are abnormal. We’ll talk about some common signs of a crisis, and examples to use as reference below. 

 

Why is Crisis Intervention Important?

Knowing that over half of individuals in recovery also have a mental health diagnosis, co-occurring disorder, it’s important to feel confident navigating crisis intervention. A crisis can happen to anyone, but individuals with a known mental health disorder are at increased risk of experiencing a crisis. Because of this, it’s likely that you will need to deploy de-escalation and intervention techniques along the course of working as a Peer Provider. Knowing how to respond in a crisis scenario is extremely important. It can potentially save a clients’ life. 

 

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Signs of a Crisis

Below are some of the most common signs of a crisis. We’ve included examples to give a bit more context, and guidance when approaching interventions. 

 

Hopelessness

If your client typically displays optimistic behavior, and suddenly expresses feelings of extreme hopelessness, this may be cause for concern. On the flipside: if you are working with someone in early recovery who has consistently felt doubtful of the recovery process, this may be considered typical behavior. 

 

Poor concentration

Has your client recently been sidetracked during all of your recent appointments? Do you find it hard to keep their attention for more than a few seconds? Pay attention to this if it’s a change in typical behavior, especially if continued.

 

Irritability

We all get irritable from time to time. Irritability is viewed as a sign of crisis only when a client experiences more irritability than usual, or extreme shifts in behavior. 

 

Conflicts with others

As described above, conflict is a typical experience to some degree. Is your client in conflict with others an increasing amount? Does it seem like they are constantly in conflict with others? Over the course of working with them, is this a new development? These are all important factors.

 

Avoiding social situations

While working with your client, have they always asked to meet at recovery events and suddenly wanted nothing to do with it? Have they stopped being as responsive? If you notice your client suddenly does not want to attend any social events, this may be important to note.

 

Anger

As mentioned with irritability, if your client suddenly displays anger, rage or irritability you may want to pay attention. While working with this client, have they typically seemed to self-regulate well? If they are suddenly displaying signs of anger, they may be experiencing emotional distress.

 

Grief

Grief can be triggering for anyone experiencing loss of any kind. Because of the emotional toll grief has on us, it can sometimes trigger a crisis situation. 

 

Denial

When talking with your client about their recovery wellness plan, have they started to deny critical parts of their past? Are they refusing to acknowledge specific areas of their life? Denial is typically seen when someone is overwhelmed with a truth about themselves or another, and reusing acknowledgment seems easier to do. Pay attention to your client if you notice this happening.

 

Difficulty eating or sleeping

Is your client showing up to appointments tired and expressing difficulty with eating? Specifically over the course of days and weeks, this is an indicator that something may be causing stress to your client.

 

Abusing alcohol and/or drugs

If your client experiences a return to use, this can be the result of a mental health crisis. If a client returns to use, review their wellness plan and ensure the entire care team is aware. Notice if your client displays any other signs of crisis, this may mean that they require more intervention.

 

Apathy

Pay attention to your client if you’ve noticed a shift in their overall interest. Were they once excitable, enthusiastic and now apathetic towards most things? Apathy can be a sign that a client is “numbing things out” or feeling less invested in their recovery. 

 

Depression

Depression is a common mental health diagnosis that many individuals in recovery experience. While depression itself is not always an indicator of a crisis, heightened depressive episodes can be. Take note of behavioral changes, and increased symptoms of depression as these can indicate the need for intervention.

 

Anxiety

As with depression, anxiety is one of the most common mental health diagnoses. An increase in anxious thoughts and behaviors can be the result of, or trigger a crisis situation. 

 

How to Respond

If you’ve reviewed the above criteria and feel that a client is experiencing an imminent crisis, here is how you can intervene.  

 

  • Call 911
  • Ask for help from nearby bystanders if needed
  • If it’s safe, stay with your client until help arrives
  • Stay calm, and try to respond empathetically
  • Don’t allow your client to engage in dangerous behaviors
  • Encourage them to contact other members of their care team for further support

 

Please let your Supervisor know if you have to intervene on a client crisis.

 

Context Matters

All signs of a crisis situation are highly subjective. It’s important to regularly check in with clients to maintain a good understanding of where they are at along their recovery. The same applies to crisis scenarios. If you consistently check in with your clients, you will have a good baseline for their typical behavior and will notice more easily when there is something “off”. 

 

Learn More About Crisis Situations

Oftentimes a crisis situation can be triggered by specific events. Being aware of your clients triggers and reviewing this when creating their recovery plan can help you prepare for any potential crises. Learn more about triggers here.

 

Sources:

 

NAMI. “Navigating a Mental Health Crisis.” National Alliance on Mental Health, 2018. https://www.nami.org/Support-Education/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis/Navigating-A-Mental-Health-Crisis. Accessed 3 May 2023. 

SAMHSA. “Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Association, 2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm#mhisud. Accessed 3 May 2023.