1. Section 12: Crisis Intervention UCLA

2. Give me some examples Form groups of 4-6. Agree on 3 examples of crises faced by your staff What made these crises challenging to deal with? 2

3. Things to Consider When Facing a Crisis

4. Things to Consider… Are you safe? Are other clients safe? Is the client in crisis safe? Can I handle this? What other resources do I need? How do I feel better after it’s over? 4

5. Are safe? Are you safe? Protecting your safety is protecting the safety of the client If they hurt you They will no longer feel safe, They will no longer be able to receive treatment from your agency Putting your safety first is in the best interest of the client. 5

6. Keeping yourself safe… The Office Setup Be conscious of where you are in the office 6

7. Counselor Client Counselor Client 7

8. The Office Setup Be conscious of where you are in the office Be aware of ways of asking for help Keeping yourself safe… 8

9. Be careful not to reflect negative emotional states Watch your body language Stay calm and keep you voice tone low and soft Be careful not to stand over or lean into patient Personal Style 9

10. Keeping yourself safe… Get out Take a break Leave the office Leave the building Get help Call a supervisor Call a colleague Call the police If none of that works… 10

11. Things to Consider… Are you safe? Are other clients safe? Is the client in crisis safe? Can I handle this? What other resources do I need? How do I feel better after it’s over? 11

12. Are other clients safe? Where is the crisis happening? If other clients are observing, they may not feel safe We do not want to contribute to the chaos of their lives They want to have confidence in their environment. A crisis with one client may lead to a crisis with another 12

13. Keeping other clients safe… Calm the participant (and you) Protect confidentiality Protect other clients from direct harm Protect other clients from “helping” Remove the situation to a quiet, safe place. This will help to: 13

14. Things to Consider… Are you safe? Are other clients safe? Is the client in crisis safe? Can I handle this? What other resources do I need? How do I feel better after it’s over? 14

15. Is the client in crisis safe? Is the Client a danger to: Self? Others? If danger = being aggressive, follow recommendations above If danger = killing self or others, follow recommendations above AND make sure they get assessed. 15

16. What is a Suicide/Homicide Assessment? If you think that someone wants to kill him/herself or someone else, they must be evaluated. If risk is significant, they may need to be hospitalized If risk is minimal, a plan needs to be developed in case feelings get worse. 16

17. 17 Risk factors  Common psychiatric risk factor leading to suicide  Depression*  Major Depression  Bipolar Depression  Alcohol and Drug abuse and dependence  Schizophrenia  Other psychiatric risk factors with potential to result in suicide  Post Traumatic Stress Disorder (PTSD)  Eating disorders

18. 18 Risk factors for Suicide Symptom Risk Factors During Depressive Episode Desperation Hopelessness Anxiety/psychic anxiety/panic attacks Sudden change in mood Aggressive or impulsive personality Has made preparations for a potentially serious suicide attempt or has rehearsed a plan during a previous episode Recent hospitalization for depression Psychotic symptoms

19. 19 Risk factors Major physical illness-especially recent Chronic physical pain History of trauma, abuse, or being bullied Family history of death by suicide Drinking/Drug use Being a smoker

20. 20 Symptoms and Danger Signs Warning Signs of Suicide Danger Talking about suicide. Statements about hopelessness, helplessness, or worthlessness. Preoccupation with death. Suddenly happier, calmer. Loss of interest in things one cares about. Visiting or calling people one cares about. Making arrangements; setting one's affairs in order. Giving things away, such as prized possessions.

21. 21 Symptoms and Danger Signs Warning Signs of Suicide Warning Signs Observable signs of serious depression  Unrelenting low mood  Hopelessness  Anxiety  Withdrawal  Sleep problems Increased alcohol and/or other drug use Recent impulsiveness and taking unnecessary risks Threatening suicide or expressing strong wish to die Making a plan (giving away possessions, obtaining other means of killing oneself)  Unexpected rage or anger

22. 22 Assessment of Suicide History Influences Lethality Psychological Organization Evaluation of Risk Potential Recommendations

23. Crisis Intervention: CASE STUDIES  The following two case study exercises present crisis scenarios. Please break out into groups of 2-4 and carefully read each scenario, then write down your response as counselor. You will then share your responses to the class. 23

24. Exercise 1 Case Study 1: Farida Farida is a 25-year old Ritalin and Valium addict with 3 months of sobriety, whom you have been seeing once a week. When she walks into your clinic today, she appears forlorn and acts withdrawn. She refuses to answer your open-ended and closed-ended questions. Finally, she mutters, “My husband is seeing another woman and he told me he is leaving me. Without him, my life isn’t worth living anymore. I just want to go to sleep and not wake up.” What do you do? 24

25. Exercise 2 Case Study 2: Mariam Mariam is a 32-year old heroin addict who comes to your clinic for a scheduled appointment. She has not used drugs for 1 month. Today she seems uncharacteristically happy and in a calm, almost content state. You know she has tried to commit suicide 3 times in her past. When you ask her if she has had any thoughts of suicide lately, she responds, “Oh, I don’t know…maybe once or twice. No big deal.” Describe your next steps. 25