Crisis Intervention

1. Assisted Living Facility Limited Mental Health Training Crisis Intervention

2. Florida’sPlanning Council Advocacy + Effective Planning Councils= Quality Services

3. Crisis Risks for Persons with Severe Mental Disorders Crisis Risks for Persons with Severe Mental Disorders • For most people with serious mental health disorders, symptoms change over time; that is, they get better or worse as a result of normal life stresses. • The nature of symptoms can lead to a crisis. • Many people with a serious mental health disorder experience depression. Sometimes, suicide is believed the only way to get help with their pain. • Some people with serious mental health disorders may have difficulty coping with stressful situations.

4. Be Aware of Situations that can Lead to a Crisis Be Aware of Situations that can Lead to a Crisis • Stops taking medications • Begins using illegal drugs or alcohol • Increases in hallucinations • Saying things that don’t make sense • Stops talking, avoids people, and appears to lack energy • Mood or attitude changes suddenly or frequently • A stressful situation occurs such as an acute health problem or the loss of a significant other

5. Act Early Act Early • Ask about thoughts and feelings • Encourage them to talk • Ask the person what you can do to help • Do not ignore the situation and hope it will go away • Simply giving some of your time, a good listening ear may prevent a crisis • Not paying attention and failing to respond early may lead residents to believe that attention only comes when they are in a crisis

6. ActEarly Act Early (cont’d.) • Know what mental health services and transportation is available in your community • Know what resources are available to each person • Know what arrangements have been made by your ALF for emergencies • Be familiar with responsibilities and limitations related to assistance from law enforcement

7. Communicate With Others Communicate with Others • Tell other staff at your ALF what changes you have observed. • Contact the person’s case manager, counselor or therapist to express your concerns. • Establish a means to communicate regularly with other people involved in the person’s treatment. • Keep case managers informed of changes you observe. • Encourage the person to let you know when things are going well for them and when they are not. • Listening to the person is always helpful

8. Developing a Crisis Plan Developing a Crisis Plan • Make certain that important information regarding each resident is available at the assisted living facility. • Have an agreement and written procedures for responding to a crisis. • Train your staff on how to follow the plan. • Review with the residents what they can do if they are in a crisis.

9. Evaluating a Crisis Evaluating a Crisis • Plans • When or how immediate • Behavior changes • History

10. De-escalation Approaches 1. Sort out the facts to determine who was involved, what occurred, when it occurred, where it occurred, and why the person is upset; 2. Focus on opportunities for resolution rather than the challenges; 3. Prioritize options for shared decision-making; and 4. Follow-upto prevent re-escalation.

11. Questions to Ask Is the person disoriented? What are the person’s plans? How immediate are the person’s plans? What behavior changes have you observed? What is the person’s history?

12. Responding to a Crisis Responding to a Crisis • Remain calm. • Be aware of the immediate surroundings. • Give the person plenty of space. • Tell the person what you are going to do before you do it. • Take a hopeful stance that the situation can be dealt with successfully. Try to establish trust and rapport with the individual. • Communicate clearly.

13. Myths About Suicide Myths About Suicide 1. Talking about suicide will give someone the idea to try it. 2. People who talk about suicide do not act on it. 3. If someone really wants to commit suicide, no one can prevent it. 4. Someone who has made a number of suicide attempts is not really serious.

14. Suicide Prevention Suicide Prevention 1. Be alert to warning signs of suicidal intent. 2. Be supportive. 3. Protect the person in the immediate situation.

15. Violence Violence 1) Evaluate the potential for violence. Do not ignore threats of violence. 2) Take action to reduce the risk of someone being hurt. Do not hesitate to ask for help from other staff, mental health professionals, case managers, police, etc. 3) If you believe that the potential for violence exists, contact mental health professionals, case managers, and facility staff for an examination.

16. The Baker Act The Baker Act • Provides the criteria and procedures necessary to intervene in a crisis situation where an individual may be a danger to him/herself or others due to symptoms or conditions of their mental disorder. • Protects people from unnecessary or inappropriate commitment; therefore, the criteria and procedures are specific with a strict definition of what constitutes a mental health crisis requiring use of the baker act.

17. Voluntary Examinations Criteria Voluntary Examination Criteria • Person has requested or agreed on their own to a psychiatric examination. • 18 years old or older. • Legally competent. • If 17 years old or younger, then the guardian would provide the request for an examination

18. Voluntary Admissions Criteria Voluntary Admissions Criteria • An examination has determined the person meets criteria for inpatient emergency treatment. • Person has requested or agreed on their own to psychiatric treatment. • 18 years old or older. • Legally competent to give informed consent. • If 17 years old or younger, then the admission would occur only after a court hearing to verify that the consent is voluntary.

19. Exceptions for Voluntary Admissions Exceptions for Voluntary Admissions • Person is 60 years or older with diagnosed dementia and has not been assessed for their ability to give an informed consent. • Person has been found incapacitated by a court and a guardian has been appointed. • There is a healthcare surrogate or proxy currently consenting for the person’s medical or mental health treatment.

20. Who can Initiate an Involuntary Examination? Who can Initiate an Involuntary Examination? • Court order stating the person appears to meet the criteria for involuntary examination. • A law enforcement officer can transport a person to a receiving facility who meets the criteria for involuntary examination. • A physician, clinical psychologist, psychiatric nurse, clinical social worker, or licensed mental health counselor can complete a certificate stating they have examined the person within the last 48 hours and found the person met the criteria for involuntary examination.

21. Crisis Intervention Trained Officers Some police departments/sheriff’s offices have implemented Crisis Intervention Training (CIT)This involves training some officers on issues specifics to persons with mental health disordersWhile any law enforcement officers may initiate a Baker Act exam, in any situation where you need to call law enforcement (including to consider a Baker act exam) you should ask if a CIT trained officer/deputy can come to the ALF.

22. Involuntary Admission Criteria Involuntary Admission Criteria • Person has refused a voluntary examination even after receiving a clear explanation of the procedures and purpose of the examination. • The person is unable to determine for himself or herself whether an examination is necessary. • Without care or treatment the person is incapable of caring for him/herself even with help from a significant other. • The person is likely to harm him/herself or others in the immediate future.

23. Get to Know theResidents as Individuals Get to Know your Residents • Likes and dislikes • Sleep habits • Daily routines • People they spend time with • What is stressful to them • How they cope in difficult situations • Any information that helps you know them when they are not in crisis so that you can tune in to changes when they occur