Mental Health Crisis Guide
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This document discusses crisis theory and intervention, including various types of crises, grief, loss, and several forms of abuse and their assessment and treatment. It covers phases of a crisis, types of grief, nurse's role in addressing grief and loss, suicidal behavior assessment and interventions, family violence characteristics and interventions, child abuse assessment and reporting obligations, latchkey children risks, elder abuse contributing factors and signs, and rape trauma syndrome treatment. The priority is to provide a safe environment, report suspected abuse, and assist with care, documentation, and referrals.
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Mental Health Crisis Guide
- 1. PYRAMID POINTS MODULE 71: CRISIS THEORY AND INTERVENTION de 1
- 2. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS I. Crisis Intervention Description A temporary state of severe emotional disorganization caused by event that presents a threat Outcome depends on coping mechanisms and support systems. Phases of a crisis Phase 1: External precipitating event Phase 2: Perception of threat, increase in anxiety, may cope or resolve crisis Phase 3: Failure of coping, emergence of physical symptoms Phase 4: Mobilization of internal and external resources, goal is to return to at least precrisis level of functioning. Slide 2
- 3. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS I. Crisis Intervention (continued) Types of crises (Box 71-1) Maturational Situational Adventitious Crisis intervention Treatment is immediate, goal-directed, supportive, and directly responsive to immediate crisis. Slide 3
- 4. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS II. Grief Natural emotional response to loss during acceptance of the loss Usually involves moving through series of stages, tasks to help resolve grief Feelings associated with grief include anger, frustration, loneliness, sadness, guilt, regret, peace. Healing can occur when pain of loss has lessened, survivor has adapted to the loss. Types of grief Normal grief, physical, emotional, cognitive, or behavioral reactions can occur; resolution process can take months to years. Anticipatory grief occurs before loss of loved one. Disenfranchised grief occurs when loss of loved one experienced but cannot be acknowledged openly. Dysfunctional grief occurs with prolonged emotional instability and lack of progression to coping with loss. Children’s grief is based on developmental level of child. Slide 4
- 5. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS III. Loss Absence of something desired, previously thought to be available Actual loss Perceived loss Anticipatory loss Mourning, outward and social expression of loss Bereavement, includes grief and mourning Slide 5
- 6. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS IV. Nurse’s Role: Grief and Loss (Box 71-4) Includes communicating with client, family members, significant others Allow ongoing opportunities for fully informed choices. Facilitate grief process. Consider survivor’s culture, religion, family structure, individual life experiences, coping skills, support systems. Affects survivors physically, psychologically, socially, spiritually Use interprofessional collaboration approach to care. Slide 6
- 7. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS V. Suicidal Behavior Description Client has feelings of worthlessness, guilt, and hopelessness that are overwhelming, feel unable to go on with life. At-risk groups include adolescents, older adults, disabled or terminally ill clients, substance abusers, and depressed clients. Clues (Box 71-5) Giving away possessions, making or changing a will, physiological alterations Assessment (Box 71-6) Client plan, history of attempts, psychosocial issues Slide 7
- 8. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS V. Suicidal Behavior (continued) Interventions Assess for suicidal intent and initiate suicide precautions. Provide one-to-one supervision at all times. Suicide precautions Develop a contract with client. Provide nonjudgmental caring attitude. Identify support systems. Slide 8
- 9. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS VI. Abusive Behaviors Anger Feeling of annoyance displaced onto an object or a person Aggression can be harmful, destructive when uncontrolled. Violence is physical force threatening safety of self, others. Assessment Includes physiological and psychosocial disturbances Making verbal threats, muscle rigidity, glaring at others Interventions Maintain safety. Use a calm and assertive (not aggressive) approach. Acknowledge client’s anger and determine client’s needs. Provide client with options to deal with the behavior. Slide 9
- 10. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS VI. Abusive Behaviors (continued) Restraints (security devices) and seclusion Used when behavior physically harmful to client or others, or when alternative or less restrictive measures insufficient Used when client anticipates that controlled environment would be helpful, requests seclusion Require health care provider’s written prescription; must be reviewed according to agency policy, specifying type of restraint, duration of restraint, seclusion, criteria for release Client in restraints or seclusion needs constant one-to-one supervision. Physical, safety, comfort needs assessed every 15 to 30 minutes, with documentation. Always follow agency procedures and policies. Slide 10
- 11. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS VII. Bullying Abuse of power by a person through repeated aggressive acts Most often occurs in children and in high school or college environments but can also occur in the workplace or on the Internet Bully feels power from sources such as physical strength, maturity, a higher status within a peer group, from knowing the victim’s weaknesses, or from support of others. Slide 11
- 12. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS VIII. Family Violence Description (Figure 71-1) Threats and verbal or physical assaults by abuser on family member (victim) Types of violence (Box 71-7) Physical Sexual Emotional Physical neglect Developmental neglect Educational neglect Economic exploitation The vulnerable person The one in the family unit against whom violence is perpetrated Slide 12
- 13. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS VIII. Family Violence (continued) Characteristics of abusers Perceive victims as their property and are entitled to abuse them Characteristics of victims Children and older adults are most often abused. Victim feels trapped, dependent, helpless, and powerless. Interventions Provide a safe environment. Assess for and care for physical injuries. Report suspected or actual cases of child or older adult abuse to appropriate authorities. Maintain accurate and thorough medical health records. Slide 13
- 14. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS IX. Child Abduction Because of the increased independence that occurs in the preschool-age child, parents are less able to provide the constant protection they once did when the child reaches this age; interventions (including teaching the child) that ensure protection are necessary. Interventions Instruct the parents to teach a child basic guidelines about personal safety. Teach child full name, address, and parent’s name. Watch for posttraumatic stress disorder in child who has experienced abduction. Slide 14
- 15. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS X. Child Abuse Description Involves physical, emotional, sexual, or neglect maltreatment Assessment (Box 71-9) Shaken baby syndrome Child abduction Interventions Report cases of suspected child and elder abuse to appropriate authorities. Support victim during thorough physical assessment. Provide a safe environment. Refer family to appropriate support groups. Slide 15
- 16. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS XI. Latchkey Children Description Children who do not have adult supervision before or after school hours; they are left to care for themselves during these times. Induces stress-provoking environment for children Children at risk for unsafe situation, injury, and delinquent behavior Interventions Identify latchkey child. Encourage parent to teach child about self-care and self-help. Inform parent about available community resources. Slide 16
- 17. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS XII. Abuse of the Older Adult Description Contributing factors include long-standing family violence, caregiver stress, and older adult’s increasing dependence on others. Victims may attempt to dismiss injuries as accidents. Abusers may prevent victims from receiving proper medical care. Assessment Signs of physical, sexual, emotional abuse, neglect, medication overdose, or economic exploitation Interventions Report cases of suspected abuse to appropriate authorities. Provide a safe environment. Provide referrals to emergency community resources. Slide 17
- 18. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS XIII. Rape and Sexual Assault Description Engaging another person in a sexual act through use of force and without consent Acquaintance rape Statutory rape Marital rape Assessment Provide privacy. Obtain physical evidence. Note that males may be sexually abused both as children and adults; usual target of pedophiles. Rape trauma syndrome See Chapter 69 for information on posttraumatic stress disorder. Slide 18
- 19. MENTAL HEALTH: Crisis Theory and Intervention PYRAMID POINTS XIII. Rape and Sexual Assault (continued) Interventions Assess victim’s stress level before performing treatments, procedures. Stay with victim. Obtain consent for exam, photographs, laboratory tests, release of information, and then assist with obtaining physical evidence and laboratory samples. Treat injuries and provide safety. Provide crisis intervention and use of support groups. Document all events in care of victim. Slide 19
- 20. MENTAL HEALTH: Crisis Theory and Intervention Audience Response System Question (for use with iClicker) The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority instruction should be included in the discharge instructions? 1. Information regarding shelters 2. Instructions regarding calling the police 3. Instructions regarding self-defense classes 4. Explaining the importance of leaving the violent situation Slide 20