How to De-escalate a Mental Health Crisis in the Home

During this time of sheltering in place and while America is on ‘pause’, many families are experiencing stress from many different directions. In an effort to keep everyone safe and slow the spread of the COVID-19 viral pandemic, non-essential businesses, schools and a host of  service provider agencies are temporarily closed. Parents are at home from work, children are at home from school-the entire family is under one roof, together 24 hours each day. For some families, that dynamic alone, can be stressful, and may overwhelm-challenging their ability to share the same space without incident.

There is one population about whom we rarely mention–those with existing mental health disorders or psychiatric diagnoses. Persons with anxiety disorders, depression and with psychoses- are also at home. Depending on the diagnosis and level of severity, many with mental health conditions have their illnesses managed with prescription medication. Day habilitation and outpatient treatment programs are likely closed in this health crisis. Supports are limited, and it is up to the skills of the family to maintain functioning levels.

There is always the possibility,  particularly while in self-isolation, that someone in your home may experience a mental health crisis. It may be a first time occurrence, which can be scary for both that person and the loved ones at home. Should a loved one in your home experience a crisis, it is important that you are prepared, by being able to recognize a mental health crisis when you see it, and have a working knowledge of things you can do to de-escalate the situation. Priority number one is to reduce the potential for harm.

WHAT IS A MENTAL HEALTH CRISIS?

A mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community.

Many things can lead to a mental health crisis and examples of situations that can lead or contribute to a crisis include:

  • Home or environmental stressors
  • School/work stressors
  • Using or abusing drugs/alcohol
  • Starting new medication or new dosage of current medication
  • Stopping medication or missing doses
  • Treatment stops working

Anyone that may be going through a mental health crisis may experience guilt, anger, or grief. It is important to address a mental health emergency quickly and effectively. Some individuals who are dealing with a mental health illness may not exhibit any warning signs. Please remember no one is to blame, not the person or the family.

WARNING SIGNS OF A MENTAL HEALTH CRISIS

It is important to know and recognize the warning signs that an individual may be struggling with so that you can support them in the best way possible.

According to NAMI (National Alliance on Mental Illness), these are the most common warning signs:

  • Inability to perform daily tasks, bathing, getting dressed, etc.
  • Rapid mood swings
  • Increased agitation, risk-taking/out of control behavior
  • Abusive behavior to self or someone else
  • Isolation from school, work, family, and friends
  • Loss of touch with reality
  • Paranoia

 

Keep these important techniques in mind in the event of a crisis. Remember that you are there to listen, be supportive, and get the person the help they need. Do your best to remain calm, and let them know that you are there for them and they are not being judged.

  • Keep your voice calm
  • Avoid overreacting
  • Listen to the person
  • Express support and concern
  • Avoid continuous eye contact
  • Ask how you can help
  • Move slowly
  • Offer options instead of trying to take control
  • Be patient
  • Avoid touching the person unless you ask permission
  • Gently announce actions before initiating them
  • Give them space, don’t make them feel trapped
  • Don’t make judgmental comments
  • Don’t argue or try to reason with the person

 

5 Steps for Mental Health First Aid

You can help in a crisis situation by following the ALGEE action plan:

A– Assess for risk of suicide or harm
L– Listen non-judgmentally
G-Give reassurance and information
E-Encourage appropriate professional help
E-Encourage self-help and other support strategies

What Is A ‘Safety Plan’?

  • Step 1 – Warning signs that a crisis may be developing
  • Step 2 – Internal coping strategies, things I can do to take my mind off my problems without contacting another person (relaxation technique-physical activity)
  • Step 3 – People and social settings that provide distraction.
  • Step 4 – People whom I can ask for help.
  • Step 5 – Professionals or agencies I can contact during a crisis. (Therapist, emergency contact, AA, NA, PACT team worker)
  • Step 6 – Making the environment safe.

If you cannot de-escalate the crisis yourself, you can seek additional help from mental health professionals who can assess the situation and determine the level of crisis intervention required. There is nothing wrong with asking for help. You just might save the life of a loved one.

At The Intersection of Culture and Mental Health

man beside flat screen television with photos background

Culture and mental health intersect. That thought speaks volumes to professionals and practitioners everywhere-all across the globe. If it doesn’t, it ought to! Have we considered how many times that life-altering mental health diagnoses have been wrong?

In a recent article, a PhD. psychology student, saw a male client who presented with symptoms of feeling insects crawling under his skin. Yes, insects The doctoral student consulted with her supervising psychology professor, as she was leaning towards a diagnosis of schizophrenia.

The professor asked a key question of his student. “Was this person Nigerian?” That question may sound irrelevant. However, when making determinations of life- impacting proportions, this is a most wise question. A wrong diagnosis can determine the degree of one’s life quality, quite literally.

The intern answered affirmatively.  But why was that a critical consideration before diagnosis? Nigerian culture recognizes a phenomenon called Ode Ori. In Yoruba, this form of acute distress is manifested by a crawling sensation in the head and under the skin, heart palpitations and noises in the ear. These symptoms are expressions of and accompany anxiety.

Anxiety calls for different treatment protocol than schizophrenia, a psychotic disorder. Fortunate for everyone, especially the client, the distinction was made before being subjected to inappropriate, erroneous and ultimately ineffective harmful treatment. In the West, those symptoms are most closely associated with schizophrenia, and absent a broadened view of culture and mental health, a relatively normal neurosis may be diagnosed more severely.

Culture shapes who we are, so it follows that it would also shape our manifestations of stress, mental disorder, and emotion. Yet, that also implies a kind of messiness that modern psychology and psychiatry, particularly the American kind, have been struggling to ‘clean up’. 

Delivering the best care for individuals requires a more adaptable model-one which transcends culture, while not ignoring cultural influences, traditions and expressions of wellness. One culture’s expression of distress might look different from another’s. We must cease making these expressions of emotional distress so exotic.

Clinicians, educators, practitioners and everyday people are now called to be more fluent in the varying manifestations of emotional distress, in whatever language they present in translation. The Diagnostic and Statistical Manual 5th Ed.[DSM-5], the bible of psychological disorders and conditions, has rightfully moved from a simple list of ‘culture-bound disorders’ to what’s now called ‘cultural concepts of distress’.

In Western cultures, we are socialized to regularly ask ourselves how we feel and to name our emotional states from very early ages. This thinking can’t dominate our perceptions or diagnoses of individuals or culturally diverse groups of individuals.

Phenomenological awareness is subjective reality. What is cold to you may not be cold to me. People who hear voices in their heads would typically characterize a major symptom of schizophrenia. However, folks from Ghana and India tend to report having positive spiritual relationships with their voices. Thus, a psychotic disorder can not apply across the board here.

Since their founding, psychology and psychiatry have striven to standardize the diagnosis and treatment of mental disorders, indeed a difficult task. Culture and social environment can predict, and shape common mental disorders such as depression and anxiety. It is still uncertain whether the fundamental mechanisms of mental health are the same across humanity and it’s the expression of disorder that vary across cultures…or whether they are distinct culturally-mediated disorders.

three women sitting on grass

With that in mind, it behooves professionals in all social psychological and education fields to use caution when assessing degree of wellness or intelligence. Capacity and the assessment and perception of adaptive behaviors also fall into this area of well-advised caution. Because there are culturally diverse individuals in American society, we must constantly be mindful of the ways culture and mental health intersect.

 

Why Are White Children Using Guns To Solve Problems?

Shocked was I when I heard about yet another school shooting. In California, another distraught and confused youngster, 16 years old, entered his school and shot and killed classmates. It happened during what the school calls Zero Hour’. What is most hoped for is that, at that hour, there were zero incidents in that learning environment.

Right now, America is operating in reactive mode. Surprised, confused, sad, angry, hurt and dead, all certainly descriptors in the aftermath. By this time, one would hope that we would be more proactive, doing more acting than talking, and preventing these types of tragedies from reoccurring in the U.S.

When we speak about gun violence in this country, we usually refer to the violence plaguing the inner-cities, where the poorest and most dark complexioned people live. But, once again, the mass violence NEVER occurs in these communities, by those people. Violence is violence by any means. When violence is turned outward into society, an entire population, we are all forced to do something. We take notice;we have no other choice.

It is frightening to feel as though, at those moments, or any moment where mass violence is committed, it could have been you or I or our children. Why at school? What is it about the school setting that makes it attract such acts of violence? What makes kids feel safe enough to express their anger, frustration, hurt or emotions they themselves may not understand?

Schools are supposed to be safe and supportive environments. It is in school that children learn about themselves, society and their place in society. During the teen years, in particular, youth are struggling with emotional literacy, and they are struggling to be and feel accepted, love, recognized and validated.

It is disturbing to know that the persons who commit these ‘unthinkable’ acts, walk among adults and their peers at least 5 days a week. But, no one saw, suspected, feared a powder keg rising? Not one teacher, janitor, counselor, principal noticed any signs prior to the explosion. If someone did notice a change in demeanor, and said nothing to someone else, then the title of ‘Professional’ is erroneously placed.

This is not to diminish the roles of educators in schools. Their jobs are challenging, without a doubt. But, what is it about students in classrooms, walking the halls, riding the school bus everyday that allows us to miss signs of impending distress? Are we ignoring the signs, passing the buck or waiting for someone else to take action?

Are teachers thinking that they have much more to concern themselves with, that they decide to let it go? Too many tasks already. What about the parental role? Are we expecting parents to recognize and resolve issues before becoming critical?

Can we still, in good conscience, expect parents to be super parents and omniscient when it comes to their children? Their children are released into our care and custody for the bulk of the day. Most parents are at work, and they trust that, in the best interest of their children, schools have their back. Communication is expected, not only when there are problems, but especially when there appears to be.

It’s better to contact a parent with information we have possibly misinterpreted, than not at all. Better to share observations, in the realm of being proactive, while seeking confirmation or finding that we’ve overreacted. Besides, it’s not what we say, but how we say it. As a parent, I would prefer to know that, no matter what, someone is paying attention. My kid is not just a number or face in the crowd. Knowing that would communicate to me that my child will be getting a good education in that environment, because someone’s paying attention.

I don’t know what it is about the predominantly white school communities, largely middle class, that gives children a sense of appropriateness to make the school their target of emotional outbursts of the violent types. Ironically enough, these communities are filled with adults who favor gun possession, and where, with relative ease,  obtain guns legally. Guns are in the home, for protection or sport.

From whom are they protecting themselves? According to the news media, there is little to no crime in these communities, which makes no sense. Why feel the need for a gun when there is no crime in your backyard? One would expect the argument for weapons possession should be from people living in high crime areas. That makes sense. In these areas, guns can’t be bought legally, though. When the police approach them with weapons in  their possession, it’s an arrest-able or shoot-able offense. In fact, even when there aren’t weapons, they get shot.[that’s a different argument]

Mothers don’t know about their sons having guns in the home or in their possession. On the other side of town, mothers have purchased these guns, for the family’s safety. How are these types of crimes made possible? None of it makes sense.

What is clear, though, is that a terrible tragedy befell many innocent families, and there is trauma throughout that community. Schools are being pleaded with to incorporate mental health screenings, discussions and SEL throughout the curriculum. Accompanying these efforts, family engagement needs to be embedded in the framework of education. It is not just for parents of students with special needs or IEPs. Every child has special needs.

America, what are we doing to, rather than for, our children, white children in particular, that they think solutions to problems are found down the barrel of a gun? Have we ever attempted to compare characteristics of school shooters to create a profile of those most likely to explode like this? Maybe, we would be better at recognizing when we should act when we knew the signs to look for, right? I need answers. Parents need answers, and our youth definitely need answers.

At The Intersection of Culture and Mental Health

man beside flat screen television with photos background

Culture and mental health intersect. That thought speaks volumes to professionals and practitioners everywhere-all across the globe. If it doesn’t, it ought to! Have we considered how many times that life-altering mental health diagnoses have been wrong?

In a recent article, a PhD. psychology student, saw a male client who presented with symptoms of feeling insects crawling under his skin. Yes, insects The doctoral student consulted with her supervising psychology professor, as she was leaning towards a diagnosis of schizophrenia.

The professor asked a key question of his student. “Was this person Nigerian?” That question may sound irrelevant. However, when making determinations of life- impacting proportions, this is a most wise question. A wrong diagnosis can determine the degree of one’s life quality, quite literally.

The intern answered affirmatively.  But why was that a critical consideration before diagnosis? Nigerian culture recognizes a phenomenon called Ode Ori. In Yoruba, this form of acute distress is manifested by a crawling sensation in the head and under the skin, heart palpitations and noises in the ear. These symptoms are expressions of and accompany anxiety.

Anxiety calls for different treatment protocol than schizophrenia, a psychotic disorder. Fortunate for everyone, especially the client, the distinction was made before being subjected to inappropriate, erroneous and ultimately ineffective harmful treatment. In the West, those symptoms are most closely associated with schizophrenia, and absent a broadened view of culture and mental health, a relatively normal neurosis may be diagnosed more severely.

Culture shapes who we are, so it follows that it would also shape our manifestations of stress, mental disorder, and emotion. Yet, that also implies a kind of messiness that modern psychology and psychiatry, particularly the American kind, have been struggling to ‘clean up’. 

Delivering the best care for individuals requires a more adaptable model-one which transcends culture, while not ignoring cultural influences, traditions and expressions of wellness. One culture’s expression of distress might look different from another’s. We must cease making these expressions of emotional distress so exotic.

Clinicians, educators, practitioners and everyday people are now called to be more fluent in the varying manifestations of emotional distress, in whatever language they present in translation. The Diagnostic and Statistical Manual 5th Ed.[DSM-5], the bible of psychological disorders and conditions, has rightfully moved from a simple list of ‘culture-bound disorders’ to what’s now called ‘cultural concepts of distress’.

In Western cultures, we are socialized to regularly ask ourselves how we feel and to name our emotional states from very early ages. This thinking can’t dominate our perceptions or diagnoses of individuals or culturally diverse groups of individuals.

Phenomenological awareness is subjective reality. What is cold to you may not be cold to me. People who hear voices in their heads would typically characterize a major symptom of schizophrenia. However, folks from Ghana and India tend to report having positive spiritual relationships with their voices. Thus, a psychotic disorder can not apply across the board here.

Since their founding, psychology and psychiatry have striven to standardize the diagnosis and treatment of mental disorders, indeed a difficult task. Culture and social environment can predict, and shape common mental disorders such as depression and anxiety. It is still uncertain whether the fundamental mechanisms of mental health are the same across humanity and it’s the expression of disorder that vary across cultures…or whether they are distinct culturally-mediated disorders.

three women sitting on grass

With that in mind, it behooves professionals in all social psychological and education fields to use caution when assessing degree of wellness or intelligence. Capacity and the assessment and perception of adaptive behaviors also fall into this area of well-advised caution. Because there are culturally diverse individuals in American society, we must constantly be mindful of the ways culture and mental health intersect.