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| The process of crisis assessment and intervention
Assess crisis
- Type, severity and duration
- Psychiatric or physical symptoms
- Risk of harm to self or others
Assess resources available to the person in crisis
- Personal: buoyancy, resilience, experience,
confidence
- Social: family, friends, colleagues
- Cultural: repertoire of cultural tools or rites of passage,
extended kinship system
- Professional: doctors, counsellors, community services.
To be used when the person's other resources are insufficient for
coping with the crisis. Sometimes people just need further
encouragement to draw on their existing resources, and low-key
monitoring of progress.
Intervention (Most effective in Stage II of crisis -- see Box
1)
Consultation
- provide ease of access and intensive support, allowing dependence
in the short term
- arrange time to allow "ventilation"
- encourage patients to express their fears and concerns
- discourage evasion of the problem and assist in setting realistic
goals for a solution
- encourage patients to explore possible solutions and future
directions and to feel empowered to make their own decisions in their
own time
- discuss and agree to a "contract" for managing the crisis -- set time
limits and specific goals
- avoid oversedation or premature removal of tension with medication
unless symptoms are disabling or medication is indicated for a
psychiatric illness -- otherwise, you may perpetuate a maladaptive
solution
Network
- maintain integrity of social network (involve family and friends,
find substitutes for missing confidants) -- this can only be done with
the patient's permission
- provide counselling, education and support to the patient's
partner and family as required
- if necessary, coordinate the activities of other agencies to
support the patient
- provide 24-hour availability of patient support, via a rostered
team or telephone service
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