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Course: Mental Health Nursing

Topic: Types of Crisis

The Nurses International Community

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Module Goals

Learners will be able to:

Define crisis
Explain the risk factors for crisis
Describe the types of crisis
Identify the four phases of crisis
Discuss the guiding values for nurses to support clients in crisis

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What is Crisis?

There are varied definitions and perspectives about crisis across geographical, socio-economical, political disciplines
Applies to situations that are unwanted, unexpected, unpredictable and almost unthinkable, which cause disbelief and uncertainty
In a crisis intervention document by Registered Nurses’ Association of Ontario, Crisis is defined as :

“...a time-limited response to a life event that overwhelms a person’s usual coping mechanisms.”

Zamoum & Gorpe, 2018

Milašinoviæ & Kešetoviæ, 2008

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Crisis and Mental Health

Crisis may involve a loss or change that threatens and impacts an individual’s sense of security, self-concept, self-efficacy, self-esteem.
An individual in crisis may:

Have intense feelings of personal distress (e.g., anxiety, depression, anger, panic, and hopelessness).
Exhibit changes in functioning (e.g., neglected personal hygiene, unusual behaviour).
Experience negative life events (e.g., disruptions in personal relationships and living arrangements, loss of autonomy, victimization).

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Crisis and Mental Health

Individuals who experience crisis may:

Have difficulty managing emotions and relationships.
Have feelings of shame, hopelessness, and powerlessness.

Individuals are also more open and responsive to interventions during crisis.

Crisis provides opportunity for personal evolution and growth.

However, timely crisis stabilization is necessary to prevent further negative consequences.

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Critical Thinking Question

Describe how a crisis may provide an opportunity for growth.

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Mental Health Crisis

Substance Abuse and Mental Health Services Administration defines it as- “Intense feelings of disempowerment are definitional of mental health crises…”

Non-life threatening situation where an individual exhibit extreme emotional disturbance or behavioral distress, considering harm to self or others, disoriented or out of touch with reality, has a compromised ability to function, or is otherwise agitated and unable to be calmed.

Substance Abuse and Mental Health Services Administration, 2009

University of Hawaii Honolulu

Community College, n.d.

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Mental Health Crisis

Often recognized as Mental Health Emergencies which leads to ‘too little, too late or no help at all’ in addressing root of the crisis

Identification of mental health crisis requires:

Nuanced understanding
Looking beyond whether an individual is dangerous or immediate psychiatric hospitalization is indicated

Substance Abuse and Mental Health Services Administration, 2009

Contact info: info@nursesinternational.org

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Types of Crisis

Developmental or Maturation Crisis
Situational Crisis
Disaster or Adventitious Crisis

Not all events leading to crisis are negative in nature, however all of them do present overwhelming challenges.

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Developmental or Maturation Crisis

Occurs during a developmental stage in life.

Triggered by internal conflict, caused by changes in physical, cognitive, instinctual, and sexual changes.

Examples of major life events that could trigger crisis:

Leaving home during late adolescence, marriage, birth of a child, retirement, death of a parent.

New coping mechanisms and support acquired as a response to developmental crisis may foster personal growth and development.

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Situational Crisis

Triggered by events that are external and unanticipated such as

Loss of a loved one, financial troubles, exacerbation of a chronic condition, or the experience of sudden illness.

Lack of resources and support make an individual vulnerable to crisis.

Factors that help an individual cope:

Adequate supports.
Positive emotional, mental and physical health.
Ability to understand and cope with the meaning of the stressful event.
Sense of security.

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Disaster or Adventitious Crisis

Results from unexpected, unplanned, and random events that are not part of everyday life such as natural disasters or violent crime.

May threaten survival.

May overwhelm one’s ability to cope.

Has potential to challenge a person’s basic assumptions and worldviews.
Increases vulnerability.
Causes long-lasting psychological harm.

Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

Most of the homes and buildings in a small community have been destroyed during a tornado.

What would the community nurse anticipate would be the initial nurse’s role in the readjustment process?

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Phases of Crisis (Caplan, 1964)

Phase 1:

“A problem arises that threatens the person’s self-concept, contributing to increased anxiety levels. The anxiety stimulates the use of the person’s usual problem-solving techniques.”

Phase 2:

“If the usual problem-solving techniques are ineffective, anxiety continues to rise, producing feelings of extreme discomfort. The person makes trial-and-error attempts in an effort to restore balance.”

Caplan,1964, as cited in Registered Nurses’ Association of Ontario, 2017

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Phases of Crisis (Caplan, 1964)

Phase 3:

“If the trial-and-error attempts fail, the anxiety escalates to severe or panic levels. The person adopts automatic relief behaviours (such as compromising needs or redefining the situation to reach an acceptable solution).”

Phase 4:

“When measures are ineffective and do not reduce anxiety, the person transitions into a state of overwhelming anxiety, which can lead to cognitive impairment, emotional instability”

Caplan,1964, as cited in Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Sign and Symptoms of Crisis

Inability to meet basic needs
Decreased use of social support
Inadequate problem-solving
Inability to attend to information
Isolation
Denial
Exaggerated startle response
Hypervigilance
Panic attacks
Feeling numb
Incoherence, confusion

Depression
Self-hatred
Feels strange
Perceived lack of control
Weeping
Grief/Sadness
Irritability
Being on guard or jumpy
Physical symptoms (shaking, headaches, fatigue, loss of appetite, and aches and pains

Caplan,1964, as cited in Registered Nurses’ Association of Ontario, 2017

Contact info: info@nursesinternational.org

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Guiding Values for nurses to Support

the Individual in Mental Health Crisis

Avoid harm: Ensure physical and psychological safety of client (person experiencing crisis) and those around them, treat with respect.

Intervene in person-centered ways: Care and support provided should meet individual’s needs based on their circumstances, goals, self-identified needs, and preferences for support.

Share responsibility: Empower individuals to regain control of their lives through their active participation and engagement in their care.

Substance Abuse and Mental Health Services Administration, 2009

Contact info: info@nursesinternational.org

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Guiding Values for nurses to Support

the Individual in Mental Health Crisis

Trauma-informed: Recognize and understand the impact that trauma histories have on the client.

Establish feelings of personal safety: Assist client to ‘feel safe’, develop a sense of security, and understand what may increase feelings of vulnerability.

Strength-based: Plan and implement care that makes best use of skills and strengths of the individual, such that it builds on resilience and capacity to self-manage future crises.

Substance Abuse and Mental Health Services Administration, 2009

Contact info: info@nursesinternational.org

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Guiding Values for nurses to Support

the Individual in Mental Health Crisis

The whole person: Individual needs are not limited to health-care; address other concerns related to the social determinants of health.

Client a credible source: Clients are credible sources of information regarding their needs and strengths; Do not disregard information provided by a client diagnosed with mental illness.

Recovery, resilience, and natural supports: Preserve dignity, foster sense of hope, promote engagement, incorporate values of recovery and resilience.

Substance Abuse and Mental Health Services Administration, 2009

Contact info: info@nursesinternational.org

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Guiding Values for nurses to Support

the Individual in Mental Health Crisis

Prevention: Work with client to prevent crisis in future through evaluation and considerations of contributing factor of crisis, addressing needs.

Services provided in least restrictive manner: Care should be free of coercion and social isolation.

Rights are respected: Ensure individual’s right to be heard, right to autonomy and confidentiality, right to legal counsel, right to be free from unwarranted seclusion or restraint, etc.

Substance Abuse and Mental Health Services Administration, 2009

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

How might the nurse assist a client in coping with the loss of a spouse?

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References:

Milašinoviæ, S., & Kešetoviæ, Ž. (2008). Crisis and crisis management- a contribution to a conceptual & terminological delimitation. Megatrend Review, 5(1).

Registered Nurses’ Association of Ontario. (2017). Crisis intervention for adults using a trauma-informed approach: Initial four weeks of management (3rd ed.). https://rnao.ca/sites/rnao-ca/files/bpg/Crisis_Intervention_FINAL_WEB_0.pdf

Substance Abuse and Mental Health Services Administration. (2009). Practice Guidelines: Core Elements for Responding to Mental Health Crises [PDF]. https://store.samhsa.gov/sites/default/files/d7/priv/sma09-4427.pdf

Contact info: info@nursesinternational.org

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References:

University of Hawaii, Honolulu Community College. (n.d.). What is the difference between a Mental Health Emergency and a Mental Health Crisis? [PDF]. Retrieved on January 12, 2021 from https://www.honolulu.hawaii.edu/sites/www.honolulu.hawaii.edu/files/wellness-difference-emergency-crisis.pdf

Zamoum, K., & Gorpe, T. S. (2018). Crisis Management: A Historical and Conceptual Approach for a Better Understanding of Today’s Crises. In K. Holla, M. Titko, & J. Ristvej (Eds.), Crisis Management - Theory and Practice. IntechOpen. https://www.intechopen.com/chapters/60813

Contact info: info@nursesinternational.org

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