- The experience of service users and their carers is that each person’s perception of crisis is individual.
- People themselves, family carers or friends, often recognise patterns of behaviour or external events that may indicate or trigger a crisis.
- What for one person or carer may feel manageable may for another feel overwhelming.
Defining crisis involves different perspectives
- Self-definition: defined by the person or carer as a fundamental part of that person owning the experience and their recovery. Identifying potential crises is a skill that can be developed as part of self-management.
- Negotiated or flexible definition: defined as outside the manageable range for the individual, carer or society; to use the crisis service, a decision is reached between the user and the worker.
- Pragmatic, service orientated definition: defined by the service as a personal or social situation that has broken down where mental distress is a significant contributing factor. Crisis is a behavioural change that brings the user to the attention of crisis services and this for example might result from relapse of an existing mental illness. For the team, however, the crisis is the impact of the change on the user and the disruption it causes to their life and social networks.
- Risk-focused definitions: viewed as a relatively sudden situation in which there is an imminent risk of harm to the self or others and judgement is impaired – a psychiatric emergency – the beginning, deterioration or relapse of a mental illness.
- Theoretical definitions: where crisis is viewed as a turning point towards health or illness, a self-limiting period of a few days to six weeks in which environmental stress leads to a state of psychological disequilibrium. Crisis is defined on the basis of the severity, not the type of problem facing the individual, and whether any acknowledged trigger factors for a crisis are present1.
Crises have the potential to bring about transformation and even in the case of a psychotic crisis there is the possibility of a ‘growth experience’. Overall, there is broad agreement that crisis support should therefore aim to be:
- Person centred: ensuring that the perspective of the service user and their family or carers is central.
- Asset (strength) based: where support is planned around the strengths and assets available individually and within the family unit.
- Least restrictive: options are available that help support the service user and their family with minimum coercion where possible.
- Proportionate: service options are available that allow for assessment, immediate and short term support and disposal but also more intensive crisis resolution support 2 3.
- Learning from experience: post crisis debriefing will allow service users, their carers and professionals to identify what works and what doesn’t for individuals
- Self-management focussed: the crisis is viewed as a turning point where an intervention has the potential to help the service user make changes that will resolve the crisis but also provides a learning and growth opportunity supporting future self-management. It also enables people to identify their own triggers and spot early indicators of potential crisis
Crisis cards, advanced directives and joint crisis plans enable people to articulate their needs at times of distress.