Tammy M. White, LPCC I m in Crisis. Now what? Crisis: a time of intense difficulty, trouble, or danger.
Welcome Tammy M. White, LPCC School-Community Liaison & Therapist Health Officer Mental Health and Recovery Board of Ashland Appleseed CMHC Ashland City Schools
Objectives 1. Understand the most common options available for someone experiencing a psychiatric crisis. 2. Be familiar with the process typically used to assess and determine level of care for the person in crisis. 3. Understand the difference between and significance of voluntary vs. involuntary treatment.
Common Options for a Crisis Call 24/7 Crisis Hotline 419-289-6111 Appleseed Walk-In Crisis Services Go to nearest Emergency Room (if safe to do so) Call 911 for Ambulance or Police
Factors Depends on severity of crisis Criteria Mild-Moderate symptoms, manageable or unsure Any unmanageable symptoms or concerns Physical Medical needs or suspect drugs/alcohol Violence or weapon of any kind Action Walk-In Appleseed Crisis Mon-Fri 9:00-5:00 or Hotline 24/7 Crisis Hotline 419-289-6111 Nearest Emergency Room University/Samaritan 911 Ambulance or Police
Precipitating Risk Factors Adolescence. Menopause. Retirement. Redundancy - the state of being not or no longer needed or useful Becoming homeless. Changes of role - eg, getting married, having a child, a more demanding job. Relationship problems - eg, with partners or a child. Conflict: usually due to a difficult choice where neither alternative is acceptable. Serious injury or loss of a limb. Bereavement. Post-traumatic stress. Non-compliance with medication in someone with pre-existing severe mental illness http://patient.info/doctor/crisis-intervention
Concerning Symptoms Confused thinking Prolonged depression (sadness or irritability) Feelings of extreme highs and lows Excessive fears, worries and anxieties Social withdrawal Dramatic changes in eating or sleeping habits Strong feelings of anger Strange thoughts (delusions) Seeing or hearing things that aren't there (hallucinations) Growing inability to cope with daily problems and activities Suicidal thoughts Numerous unexplained physical ailments Substance abuse http://www.mentalhealthamerica.net/recognizing-warning-signs 9/27/16
Questions to Ask Yourself Is the person showing signs or symptoms? Is the person talking about or showing signs of suicidal ideation (thoughts about suicide) Is the person using alcohol or other street drugs or on new medications? Does the person have a plan? Details? How would they complete? Does the person have the means? Firearms, stockpile of pills, knives, car, rope, belt, hose, traffic. What is the worst that can happen if I do not act now? Pros and Cons of Action Taken Discussion
Warning! Lethal Triad Ahead! Upset Individual Drugs/Alcohol Firearm
Goal of Crisis Intervention Reduce distress. Improve problem-solving strategies. Identify support system Avoid maladaptive coping strategies - eg, selfharm. Assess for suicidality/safety.
The Process Step 1 If individual has a medical condition, has recently started a new medication or is suspected to be under the influence of drugs or alcohol, they need to go to the Emergency Room and be medically cleared before and Mental Health Assessment can be completed.
Process Step 2 Amount of time it takes to complete medical clearance varies greatly on number of patients in ER and the triage process. Once the ER calls Appleseed, the On-call Pre-screener has one hour to arrive (but is usually there within 30 minutes).
Process- Step 3 When the Pre-screener arrives, he or she goes over the case with the medical staff and completes a packet of information (about 30 minutes).
Process Step 4 Pre-screener then meets with Client to go over further details and obtain signatures and conduct suicide risk assessment. Note: Pre-screener can ONLY talk to family members IF Client is a minor or Client/Guardian signs a release of information.
Process Step 5a and 5b If Client is NOT deemed a risk to him/herself or others and is NOT in psychosis, they can go home with a specific Safety Plan and follow-up the next business day with Appleseed Walk-In Crisis Dept. The Crisis Worker will re-evaluate for safety and assist Client by linking to outpatient services as appropriate (counseling, case management, psychiatry, community resources).
What is a Safety Plan? Safety Plan typically includes Being with a trusted relative or friend until follow-up. Removal of means (firearms, medications, knives, ropes, etc.) Well-checks via telephone Follow up with Appleseed or Mental Health in their county. Keeping appointments Return to ER if symptoms recur or become unmanageable. Crisis Hotline number
Process- Step 6 takes time If Client is determined to be at high risk of harm to self or others, arrangements are made to transfer him or her to a specialized Psychiatric Unit in another hospital (Samaritan does not have Psych Unit). Nearest is Med Central but there are several in neighboring counties.
Process Step 7 This is where it gets tricky. Based on availability, physical medical needs and insurance, calls are made to Admitting Departments until a suitable placement is agreed upon. Synopsis is provided and the Bed Co-ordinator advises whether a bed is available. If so, the packet is faxed to them and the psychiatrist on call is contacted and information is then conveyed to him or her. Several hospitals may be called before patient is accepted.
Process Step 8 Once Patient has been accepted, the final areas of the packet are complete and given to ER nurse to arrange ambulance transport. Patient is typically advised (some exceptions apply). Family is advised.
Patient Civil Rights In accordance with ORC 5122.10 Civil Rights protect patient in that he/she can only be held 72 hours without additional evidence that the person is a risk
Voluntary vs. Involuntary Voluntary means that the individual has good insight into the problem and is in agreement with admission into a psychiatric facility (Regarding minor children: the parent or legal guardian must be in agreement) Involuntary means that the individual has little to no insight into the problem and is unwilling to be admitted into a psychiatric unit. The Prescreener will consult with the medical staff to determine need for hospitalization.
What is a Pink Slip? Euphemism used to identify document referenced in Revised Code Section 5122.10 Document utilized to obtain emergency hospitalization for an individual who is 1) mentally ill subject to hospitalization by court order, and 2) represents a substantial risk of physical harm to him/herself or others if allowed to remain at liberty pending examination. Borrowed from Powerpoint by Marc Baumgarten, ODMH https://www.rairarubiabooks.com/related-pdf-understanding-the-use-of-pink-slipsfor-behavioral-health-patients.html
Commonly Used Terms (Psycho-babble) Mental Status Exam examines, physical, behavioral, cognitive and emotional status of client Psychosis loss of touch with reality (delusions, hallucinations) Delusion Fixed false belief Hallucination Auditory (hearing voices, static, etc., Visual (seeing people or things others cannot see); Olfactory (smells others cannot smell) etc. Crisis Intervention-Looking for risk of harm to self or others and psychosis, stabilize and release with safety plan (not a counseling session). Prescreen for hospitalization - Looking for risk of harm to self or others and psychosis prior to hospitalization (not counseling) Intake- Diagnostic Assessment done at Appleseed to begin the formal counseling process.
Psycho-babble Con t Individual Service Plan (ISP) or Treatment plan Plan developed with Client to set goals for counseling. Well-checks- phone calls made to Client to monitor (usu. during evening or weekend hours) Police Enforced If necessary and to ensure safety, police can be called to check on client if they do not answer the phone or if they are at risk during phone call. PreScreener aka Health Officer aka Appleseed Person hired by the Mental Health Recovery Board and Appleseed who will complete evaluation. Follow Up- A visit to Appleseed to talk with Crisis Worker and re-examine mental status (safety) then link to outpatient counseling and other resources.