CRISIS CARE

The following information was contributed by carers and has been printed for distribution across East Sussex. However it may also be useful to anyone who is supporting someone through a mental health crisis where they are at risk themselves or putting others at risk in some way.

Crisis Care Information – Suggestions for family & friend carers.

Some Mental Health issues can result in ‘crises’ when a person is not coping with their acute distress, agitation or anger and they or others may be at risk of harm and need urgent help. This information may be useful if you are supporting someone in this kind of situation.
How can you help?
Appear to be calm & in control – challenging for you but reassuring for them if you can.
Wait & don’t react too quickly – many ‘situations’ fizzle out, few go on to require professional help. Experience plus trial & error will help you tell the difference.
If the person has ideas that seem unhelpful or unrealistic don’t challenge these or simply agree with them. Ask how you can help them cope with the situation & their feelings rather than debating their beliefs while they are agitated.
Try not to respond to anger with anger or take personal abuse personally (really hard!)
Watch specifically for what helps to calm them. Use their name frequently & aim to listen as much as possible rather than talk.
Keep a routine, offer meals & drinks even if they are unwanted. Distract them if possible with music, games, walks or things they usually enjoy.
If they are paranoid tell them what you are doing all the time ‘I’m going to make a sandwich now.’  TV/Radio may cause anxiety & avoid unnecessary phone calls that they can overhear.
Pressurising, pleading or ‘strongly advising’ them what to do may increase tension – as will telling them to stop self harming if that is an issue. Try asking how you can help, acknowledging their feelings & calmly reassuring them they are safe.
Look for triggers that happen just before ‘flare ups’, maybe a change in routine or too much going on. Is it possible to avoid new or stressful experiences for a while?
A front door ‘spy-hole’ / door chain can help you monitor how they are when they arrive.
You can only do the best you can with the information you have at the time.                       
As you can’t control another person’s behaviour you cannot take responsibility for their actions, you can only try to help.
How do you get through this?
You are under pressure. It isn’t weak to ask for help, it is a sensible use of resources.
Call the Samaritans 116 123 if you need to offload & can talk privately. Talking to friends/family can be helpful, but there may be differences in how they see the situation.
Eating & sleeping will help you keep going, neglecting yourself will not.
Keep a diary to record key events – and remind you what you have already coped with!
Forget the ‘to do list’ & delegate daily jobs if you can. When it goes quiet then, without guilt, have a rest or a treat. This is not selfish, it is survival under pressure.
Work with the mental health team, make an emergency plan & put relevant numbers on or near your phone.
If there are repeated crises ask the person (on a good day) to sign a statement giving you permission to act on their behalf at these times & give a copy to the Mental Health team.
Ask Mental Health staff to keep what you say to them confidential if it will help. They may not be able to tell you new/personal information unless the person concerned has agreed to this, but they can always listen to you & talk about aspects of the situation you know already or ‘general information’.
Ask to be included in any care planning & don’t agree if anything doesn’t feel safe for you or others. Check & confirm new decisions & ask questions; use email if necessary. Prepare what you want to say, (write short notes & take them with you) especially for key meetings.
It’s worth working on good communication with Mental Health staff although you may not always agree with all their decisions!          
If a situation gets out of control
Your safety should take priority. If you feel at risk go behind a locked door or leave the house. If you can’t calm them quickly then it’s safer for both of you to leave them alone for a while. Try to phone them before going back or get help if this is required.
The Mental Health line (Sussex only) (out of hours inc. weekends) will advise you & talk directly to the person to calm them; however it is often really difficult to get through. 0300 5000 101
Call the Police – if there is aggression towards others, or property, or the person could injure themselves. Police may take them to a safe place or stay with them at home until they are assessed for admission to Hospital, which could take some time. The person is not arrested & doesn’t get a criminal record if their behaviour is seen as a direct result of Mental Health issues.
Call an Ambulance – if there is a serious injury/overdose. They can also take people to A&E if they are very distressed & you can’t take them. Police will be called if they are aggressive.
Take them to A&E yourself –A separate room is sometimes available after the first assessment / triage to avoid waiting (possibly for a long time) in the public area.
Going to A&E doesn’t always mean they will be *’Sectioned’, they may be offered medication, support and/or a follow up appointment.
The Mental Health Team cannot respond rapidly in the way an ‘emergency service’ can so they may not be your first call, but always keep them informed.
*‘Sectioning’ under the Mental Health Act only happens if the person needs to go into Hospital urgently because of risk to themselves or others & is unwilling to go voluntarily.
If you are part of someone being sectioned they may be angry with you & take a while to accept that it was needed for their safety.