Working Psychologically with people in a mental health crisis

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Disclaimer: This is NOT ‘professional’ advice.

When any of us are in a mental health crisis, it means different things and we think, feel and behave in different ways. What I want to convey here is how can we all work psychologically with people in a mental health crisis (or just a period of difficult mental health), whether that is working in a Crisis Resolution and Home Treatment Team (CRHT) (NHS or other) or supporting a close one when they’re in a mental health crisis/ struggling with their mental health. Side note: Suggesting / saying ‘Get on with it’ is not helpful.

The role of a CRHT is to keep people out of hospital, it’s like (generally) the stage in mental health services that sits just below hospital ‘admission’ and the ultimate goal for CRHT services is to support (termed as ‘treat’) people at home. Realistically, how many people want to go into a mental health hospital / ward? Much of the time, the answer will be “home is the preference”. However, not everybody has a ‘SAFE’ home and this is perhaps an added reason for difficulties in mental health.

From my experience working in mental health services, the Medical Model of mental health is all too present. It has its utilising benefits when people are distressed but the overuse of medication runs through mental health care. Mental health is confused from the outside in and sometimes, the inside out. Most people believe that there is a ‘chemical imbalance’ in the brain and medication will correct it, not specifically correct (will add references later). Alternatively, many people think that Cognitive Behavioural Therapy will ‘change your mindset’ and your problems will disappear, also inaccurate.

Heres an example of medication over-usage in mental health services:

“I’m distressed” – “Take some PRN” (PRN = as and when you need it medication) – The problem with this is, it doesn’t always offer an individual the understanding of the distress and doesn’t offer ‘practising’ coping techniques that are psychologically informed. It’s almost like putting plaster over a damp wall in a house, it will always crack/ crumble again. Side note: I’m using this as an example if people have not had support from clinical psychology services before which is unlikely because waiting lists are more than one year long in most cases.

Now, I’m not saying medication isn’t useful (and I am not a medical professional) but it isn’t the ‘ALL IN ONE’ answer. Also, I am aware that some people find medication useful and importantly, not everyone finds psychological input useful. Despite all of this, this isn’t about being critical of other approaches, it’s about helping people support others psychologically, who are in a mental health crisis/ struggling with their mental health.

5 KEY things I have learned when working with people in a mental health crisis:

  1. Listen to them – NO talking – What’s causing them distress? What are you hearing?
  2. How can you support them? – Sometimes, people don’t need a ‘resolution’ – they may need reassurance and a ‘listening ear’.
  3. What is their history of difficulties/ previous experiences that may cause distress? of WHAT HAS HAPPENED TO THEM?
  4. What has helped them in the past when feeling distressed? – Whether they have been in a mental health crisis or have struggled but have been able to ‘manage it’
  5. Validate them, listen to them and help them trust you. – This POINT is so key because people may have never experienced validation (like their parents or close ones telling them that it’s ok for their emotions to feel terrible) and may not trust people because of relationship experiences (not just romantic ones but the relationships they have with their family – such a key part of relationships is the early stages in childhood which we wont get into here).

Above are all principles that embed a psychological approach, tools that we can all utilise to help people in a mental health crisis. Actual ‘psychological treatments’ is not to be discussed here but you can see this recent article by Dr. Laura Jean Wells which discusses psychological formulation – to help people understand their psychological difficulties/ mental health difficulties and ‘figure out’ the best psychological treatment(s) where necessary.

What about basic things to help people in a mental health crisis?:

  • Reach out for support (for them if necessary) if they feel ‘it’s too much’ or ‘too overwhelming’ to deal with, for example, the thoughts they’re having.
  • Don’t assume they will be ‘locked away/ sectioned’ – it’s HIGHLY unlikely.
  • Go for a walk with them – fresh air is the simplest but very effective technique to deal with difficult periods of mental health
  • Make sure they are eating well
  • Help them think about sleep – VITAL for good mental health

All in all, being there for people in a mental health crisis can be tiring and if it is not your job and you’re ‘being there’ for a close one, it can be very tiring. Therefore, prioritise your own self-care too – you cannot be there 24/7, 7 days per week.

I hope this article has been useful to help you think about working psychologically with people in a mental health crisis/ struggling with their mental health. Try not to panic and get help if you feel it is needed. This article is NOT ‘professional’ advice, it is support to help people think about working with people in a mental health crisis or generally being there for someone when they’re at their possible lowest.

I hope you found this article useful and learned some helpful things about helping people psychologically in a mental health crisis. Please share the article if you found it useful, and send us any questions via Instagram or Twitter.

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