Managing Crisis Safely Rich Roell, MSW, LCSW Washington County - - PowerPoint PPT Presentation

Managing Crisis Safely

Rich Roell, MSW, LCSW

Washington County Crisis Team

Lifeworks Northwest

“Working safely may get old, but so do those who practice it.”

• - author unknown

Today’s talk…

 Introducing the Washington County Crisis Services  Your resources in a crisis  Keeping each other safe  Further training available  Communicating in a crisis

Who we are…

The Washington County Crisis Services

 Crisis Line (24 hrs): 503-291-9111  Hawthorn Walk-In Center – 9am-8:30pm daily  24-hour mobile crisis response also available

What we do…

 Urgent mental health & addictions care  Psychiatric custodies (i.e. mental health holds)  Crisis counseling, education & resource connection  Medication bridges when appropriate  All adults & children in county are eligible  No charge for any of our services

Hawthorn Walk-In Center

Elam Young Parkway Site

Hawthorn Walk-In Center

Hawthorn Walk-in Center

 5240 NE Elam Young Parkway (Hillsboro)

right next to Hawthorn Farm MAX stop

 Open every day of the year, 9am – 8:30pm  Free & confidential urgent care for mental

health & addictions concerns

How to reach us…. Washington County Crisis Line (24 hrs)

503-291-9111

Clackamas Cty Crisis Line

503-655-8585

Who to call & when…

911 (and then call us)

 Violent threats, gestures, weapons  Threatens to harm self w/ means at hand  Leaves shelter suicidal or homicidal  Unwanted physical contact  Unresponsive or incoherent  Medical emergency

Who to call & when

Crisis Team (first)

 Ideas of harm, but safe until we arrive  Non-threatening, but concerning behavior  Very distressed, unable to calm  Wants to speak with a counselor urgently  Wants to make appt with the WCCT  You want to consult

What we’ll do…

 Safety/mental health assessment  Hospitalization (if meets criteria)  Provide immediate crisis support  Discuss resources  Plan for follow-up

Factors for violence toward others

 Previous violence  Substance abuse, intoxication  Active mental illness, esp. w/ paranoia  Negative attitudes, no insight  Socially isolated, chronically unemployed  High-levels of stress  Lack of compliance with treatment/courts

What to be concerned about…

 Restlessness, agitation  Angry, fearful body language  Pressured speech or silence; intense

staring; auditory hallucinations

 Disorganization, impulsiveness  Fixation on a specific staff member

Safety Habits

 Trust your gut  Safety in numbers  Situational awareness  Talk safety with your guests  Carry your phone  Code phrases  Call for help, then assist

Safety Habits (cont’d)

 Limit self-disclosure  Remember, it’s not personal  Defusing ‘by choice’  What’s the plan?  Practice, practice, practice

It’s better to apologize for overreacting, than to regret underreacting.

GetTrainedtoHelp.com

 QPR (Question, Persuade & Refer) – 2 hours  Adult Mental Health First Aid – 8 hours  Youth Mental Health First Aid – 8 hours  Applied Suicide Intervention Skills Training – 2 days

ALL TRAININGS ARE CURRENTLY FREE

“People are disturbed not by things, but by the view s that they take of them.”

Epictetus, 1st Century A.D.

Serious & pervasive mental illness

 Mental illness disrupts a person’s normal state with

powerful shifts in the brain’s neurotransmitters

 Physical, mental, emotional & social functioning are

severely impaired, and insight is often limited

 Serious & untreated mental illness is usually beyond

anyone’s ability to cope with alone, and frequently results in a crisis

It helps to remember…

 No one wants to believe they’re sick,

much less mentally ill

 With current laws & funding, it’s difficult

to get help, even for those who are motivated

 Meds can control symptoms, but may also

create distressing & permanent side effects

Often the person is…

 is fearful

…Be calm

 is confused

…Be simple, truthful

 is insecure

…Be accepting

 has trouble

…Be brief, repetitive concentrating

Often the person is…

 is overstimulated

…Limit input

 is preoccupied

…Get attention first

 has poor judgment

…Expect limitations

 has changing plans

…Keep to one plan

Often the person is…

 feels ashamed

…Stay positive, non-blaming

 has little empathy

…Accept as a symptom

 is tired, withdrawn

…Set realistic goals

 feels stigmatized

…Don’t define the person by their symptoms

Communication specific to PSYCHOSIS, including Paranoia & Delusions

 Speak calmly & slowly,  Limit emotion  Minimize distractions  Give more personal space  Build rapport slowly, focus on problem-solving  Roll with delusions (don’t argue or endorse)

Communication specific to MOOD DISORDERS (e.g. depression, anxiety)

 Speak slowly  Limit input  Depression feels Personal, Pervasive & Permanent  Offer hope, but be honest  What’s worked before?  Be patient

Communication specific to PERSONALITY DISORDERS

 Be prepared for sudden shifts in emotions  Focus on feelings to build alliance  Avoid self-disclosing  Expect irritation, projection of blame  Keep focus on problem-solving  Remember, this is about trauma

Support

THE NATIONAL ALLIANCE FOR

THE MENTALLY ILL (NAMI) OF WASHINGTON COUNTY

18680 SW Shaw Street Aloha, OR 97007

503-356-6835

In closing…

THANK YOU!!

Please call us at 503-291-9111 if you have any questions or concerns.