Grace Notes - October 2006

Grace Notes - October 2006
By Barbara Grace

Handling Crisis Situations

Greetings to everyone and I hope you all had a great September! This month’s column is about handling those crisis situations which come up with your loved one. We all have small day to day events which can feel like a “crisis” especially if our loved one is not properly medicated, or is going through a stressful time themselves. These little daily problems (which may feel large) can have to do with cooperation in chores around the house, poor self hygiene, being argumentative, or being lethargic and unable to respond to what is going on around them. And then there can be very serious situations involving dangerous behavior, violence, or severely out of control behavior. So how can you tell if you are having a serious crisis, something that you have to call someone to help you with?

A simple answer to this question is: you need to call for outside assistance any time you feel concerned about your own safety, the safety of your loved one, or the safety of any other person (children, someone outside the family). This means that any time there is a potential for bodily harm. In mental health circumstances the definition of mandated treatment is physical harm to self or others, or the inability to take care of one’s self (such as an inability to do daily self care behaviors on ones own). Now of course the age of the person comes into account here. It is one thing to have a 5 year old throwing a temper tantrum, yelling, screaming and throwing things. And quite another to have a 40 year adult doing the same thing. The child could be subdued by parents or other adults present to keep harm from happening. However the second situation is a much more serious problem and would call for outside assistance if the person could not be calmed down by talking to them. So if you have a crisis involving serious physical behaviors what are some guidelines for these situations?

MAKE A PLAN AHEAD OF TIME. If you are concerned that your loved one could become physically aggressive, then you must sit down with them and discuss what will happen if they become violent or aggressive. Warning people ahead of time and discussing the options helps you with planning and helps your loved one understand the ramifications of their own out of control behavior. It is also true that if you surprise your loved one with outside intervention during an event, this can hurt the trust they have for you as their caretaker. So get everything out in the open and avoid surprise wherever possible. Wherever possible consult with your loved one’s therapist for input.
HAVE SOME PAPERWORK. If you ever have to call an ambulance or the police for help, you will need some documentation from your loved one’s psychiatrist about the fact that they have a mental illness and their diagnosis. When police or ambulance workers come to help you, they need to know specifics of the situation and what the truth is if your loved one denies having a problem. If your loved one is a child, this won’t be a problem –under 18 years of age. However, if your loved one is an adult you will not have access to any reports or records without their written permission to release them to you. All the more reason to discuss this with them when the situation is calm and collaborative.
HAVE AN ESCAPE PLAN. As the caretaker of a mentally ill person with one of the more serious diagnoses, be aware that things can get out of hand at any time and surprise you. It will be much better if you have a personal plan to protect yourself thought through before you need it – when your head and emotions are clear. This can involve a place to go to keep yourself safe from harm, emergency numbers, and friends or relatives who are willing to be supportive.
HAVE A PSYCHIATRIC PLAN. Work with your loved ones mental health professionals (with an adult you will need written permission) so that you all know what will happen when and if certain aggressive or other dangerous behaviors happen. In other words, should you call the psychiatrist, psychologist, social worker, hospital worker, or the police or an ambulance? Handling emergency situations out of the office takes special training and experiences. Some mental health professionals do emergency work and some do not. Know ahead of time if the professionals you are working with do this type of work.

Since handling difficult situations comes up often, I will be returning to this topic often. My new email address is BRGrace8@Comcast.net. I welcome your comments and requests for topics. Have a great month – do something special for yourself.

With blessings and love
Dr. Grace