Crisis Intervention in Social Care

Introduction

Crises can occur in various contexts, from child protection to mental health support and community services, and the number is increasing. In emergency mental healthcare alone, staff reported 17,340 serious incidents in 12 months (Mind UK, October 2023). In the latest suicide data from the Samaritans, there were 5219 suicides registered in 2021, which is 307 more than in 2020.

Anyone can experience a crisis, regardless of background, age, sex and gender. The causes and forms can also differ between individuals, and it can cause them significant distress and even harm to themselves and others in some cases. Therefore, the support and care should be person-centred and holistic and is what social care professionals provide.

Social care professionals are essential in crisis intervention and commonly form part of Crisis Teams. They can help individuals in immediate crisis and support them to find coping strategies and make sustainable changes in their lives. This blog post explores crisis intervention in social care and its principles, strategies, and importance.

Defining Crisis Intervention

The Social Care Institute for Excellence defines crisis intervention as an:

“Intervention designed to help someone cope at a time of crisis and develop strategies for dealing with the problem and the aftermath. The crisis is not necessarily an urgent situation but can be something planned in advance.”

Crisis intervention is necessary when someone is experiencing severe emotional, physical, or behavioural distress, trauma or instability due to a highly stressful and overwhelming event (a crisis) they cannot cope with, process and solve by their usual methods. They can feel hopeless and turn to harmful coping mechanisms, such as self-harm and substance abuse, and may even become mentally ill and suicidal.

It is a short-term intervention that aims to help and support an individual experiencing a crisis, help them to navigate and overcome it and reduce the risk of the event potentially causing them permanent damage (Wang & Gupta, 2023). It is also important in preventing further crises and reducing their reliance on harmful coping mechanisms.

Types of Crises in Social Care

Social care professionals have a role in helping to keep adults and children safe from harm. When someone is in crisis, they can be a risk to themselves and others, which is why early intervention is crucial. There are various types of crises social care professionals may encounter, and some examples are as follows:

• Mental health – when an individual is going through this type of crisis, they feel they can no longer function and are at breaking point. They may be anxious, suicidal or paranoid, feel like self-harming or experiencing panic attacks, flashbacks and psychosis.
• Child abuse – there may be crises where social care professionals receive reports of a child or children being physically, sexually or emotionally maltreated or neglected by parents, caregivers or others. Child abuse can have many effects and cause problems in adulthood.
• Domestic abuse – it can happen to anyone, but women tend to be the victims and men the perpetrators (Women’s Aid). It can have mental, emotional, physical, social and financial impacts, and in some cases, there is a risk of violence.
• Substance abuse – when people with substance abuse issues are having a crisis, they may turn to alcohol, illicit drugs, prescription drugs and/or other substances as a coping mechanism. In some individuals, the further use of substances can have damaging effects on their physical and mental health and well-being.
• Bereavement – the death of a loved one or friend can be distressing, shocking and frightening for some people, especially if the loss was sudden or violent, e.g. suicide, murder or traffic collision. Some find it too difficult to cope with the loss and may develop complex issues, such as post-traumatic stress disorder (PTSD) and other mental health problems and may also consider harming themselves.

Other crises may include job losses, divorce and relationship breakdowns, a diagnosis of a serious or chronic illness, homelessness and others. It is important to note that individuals vary in their response to crises, and something that may result in a crisis for one may not in another.

Crisis Assessment

The first stage of crisis intervention is a crisis assessment, which health and social care professionals must carry out as quickly as possible to determine the help and support an individual requires during a crisis. It is essential to carry out a person-centred assessment aligned with their needs and risks to ensure the response to their crisis is appropriate and accurate, as it can significantly impact patient/client outcomes. An incorrect response can lead to:

• Providing help, support and treatments that do not match the individual’s needs, wishes and preferences.
• Delays in providing help and support to individuals.
• Unnecessary A&E visits and hospital admissions when they could have help at home.
• An individual’s crisis left unmanaged, which can lead to worsening mental and physical health.
• Potential harm to the individual in crisis and others.

A crisis assessment is an interview over the telephone or face-to-face, usually conducted after a referral. There will be specific procedures and models to follow and screening tools for risk assessment and interventions, which will depend on each organisation.

Health and social care professionals will gather relevant information during a crisis assessment. They may:

• Identify what the crisis is and the circumstances.
• Ascertain whether the crisis requires an urgent or emergency response.
• Confirm the individual’s location and that they are safe (if they have called).
• Gather demographic information, such as their name, address and date of birth.
• Ask whether the individual has an advocate and whether they need to contact them.
• Find out if the individual has a crisis plan and, if so, what the details are.
• Check clinical records for previous risks and alerts.
• Ask them about their preferences, i.e. do they want to see a male or female professional, and where do they want to do the assessment?

During a crisis, it is essential to gather information in a way that does not escalate the situation further, to carry out the assessment and provide the right help and support. Here are some strategies to follow when gathering information during a crisis assessment:

• Establish rapport and build trust with the individual in crisis by being calm, empathetic and actively listening to de-escalate the immediate crisis and alleviate their distress. It also creates a safe space for the person to express themselves.
• Confirm they are currently safe and there are no immediate risks to their physical well-being to establish a foundation for further assessment and intervention. If there is an immediate risk to their safety, it may require calling the emergency services or removing them from the situation.
• Provide emotional and non-judgemental support by actively listening, validating their feelings and providing reassurance once confirmed they are safe from risk and danger. Assess their mental and emotional state and help them process the emotions they are experiencing, e.g. anger, fear and sadness, to regain some control.
• Provide clear and concise information to the individual about the assessment and what will happen while being respectful and supportive.
• When asking them questions, do so calmly and give them time to speak without interrupting, but it may be necessary to guide them back if they digress too much. It is also crucial to clarify any questions they do not understand and actively listen to them when they answer.
• Use open-ended questions at the beginning to gather more information and closed questions to clarify any important areas that have been missed or need elaboration, and certain interviewing techniques can be helpful (Tripathi, et al. 2023).
• Offer practical assistance and resources that meet their specific needs and situations to empower them to look for help and support after the immediate crisis, which may include counselling, helplines, support groups or shelters.
• Teach them coping strategies, provide information and tools to reduce their distress and empower them to gain some control to become more resilient. The strategies and techniques will depend on their needs and preferences but may include meditation, mindfulness, grounding techniques, or deep breathing exercises.

NICE has information on what should happen in a crisis in adult mental health services here.

Crisis Intervention Models

Crisis intervention models are used by social care professionals for the crisis intervention process, as they:

• Provide a foundation for a quick response to help those in distress.
• Are scientifically driven and evidence-based.
• Apply widely.
• Empower individuals to use coping mechanisms to better deal with their immediate crisis.
• Can resolve the immediate crisis.

There are two main types of crisis intervention models:

• The Seven-Stage Crisis Intervention Model.
• The ABC Model of Crisis Intervention.

The Seven-Stage Crisis Intervention Model

This model is also known as the Crisis Intervention Model, developed by Albert Roberts. It is used for a time-limited response to persons in acute crisis (Social Care Institute for Excellence). It involves the following seven steps:

• 1 – Plan and conduct crisis assessment (including lethality measures).
• 2 – Establish rapport and rapidly establish collaborative relationship.
• 3 – Identify dimensions of presenting problem(s) (including the ‘last straw’ or crisis precipitants).
• 4 – Deal with feelings and emotions (including active listening and validation).
• 5 – Generate and explore alternatives (untapped resources and coping skills)
• 6 – Develop and formulate an action plan.
• 7 – Follow-up plan and agreement.

It provides a road map to goal attainment, problem-solving, and crisis resolution (Roberts &  Ottens, 2005). When social care professionals work through these seven steps with a patient/client in crisis, it can help individuals to:

• Effectively navigate crises and trauma.
• See problems as opportunities to grow.
• Focus on the present, not the past.
• Find some stability.
• Understand their emotions and process their feelings.
• Support them to make a plan.

Further information on this model is here.

The ABC Model of Crisis Intervention

This model is a broader and more simplified version of the Crisis Intervention Model often used in mental health services and counselling. It is a short-term methodology for dealing with crises where individuals are in immediate emotional distress and trauma. It involves the following three steps:

• A – Establishing a relationship – the first step involves developing and maintaining rapport with the individual in crisis to establish a relationship built on trust and empathy.
• B – Understanding the problem – the second step involves helping the individual identify and process their feelings and perceptions connected with the crisis.

• C – Taking action – the third step of the model requires encouraging individuals to focus on coping and adaptation strategies to prevent further crises.

Using this model effectively can help individuals recognise the damaging emotional thoughts, think differently to adapt and find other ways to cope with their situations.

Establishing Rapport and Trust

To have a rapport with an individual in crisis means establishing a relationship with them to communicate well and understand them and their feelings. It is a two-way connection vital in crisis intervention and an essential foundation for building mutual trust and respect.

During a crisis, building rapport and trust with patients/clients is crucial, as it fosters an environment where individuals feel safe and comfortable to be more open about their situation, distress and trauma, especially if it involves sharing painful memories or information. It also improves collaboration, thus leading to better outcomes, healthier patients/clients, and potentially preventing future crises.

Some techniques social care professionals could adopt for effective communication and active listening are as follows:

• Provide individuals with essential information quickly, clearly, and concisely to avoid overwhelming them; brevity is key.
• Be fully present when an individual is talking and do not get distracted, e.g. not looking at a mobile phone or doing other tasks when having conversations.
• Focus on the individual and not just the problem, i.e. social care professionals should not try to provide their own solutions but empower individuals to find their own by asking them thought-provoking questions.
• Show an interest in what an individual is saying by maintaining good eye contact and using gestures, such as head nodding, to demonstrate listening. It will make individuals feel heard and valued.
• Pay attention to (and use) body language and non-verbal cues to indicate listening, e.g. facial expressions, posture, hand gestures, eye contact and eye movement.
• Ask individuals open-ended questions to get them to give detailed responses and gather more information rather than closed questions with yes or no answers.
• Reflect on the answers that individuals give, repeating what they have said to check accuracy, asking further questions to check understanding and summarising to demonstrate that they were heard and understood.
• Avoid judging an individual or trying to provide advice, but listen to understand their situation and problem. Be patient and allow the person to speak without interruption.

Crisis De-escalation Techniques

People in crisis can go through a wide range of emotions, such as anger, fear, irritation and sadness. Some may also be experiencing mental health or substance abuse issues, and there can be a risk of them harming themselves, becoming agitated, abusive, aggressive and violent to others. Therefore, de-escalation is crucial in managing high-stress situations to get individuals to calm down and reassure them.

De-escalation, according to NICE means:

“Using techniques, both verbal and non-verbal, to reduce agitation and avoid violent and aggressive behaviour. It may include the use of ‘when needed’ medication in combination with other techniques”.

Staff should receive training in de‐escalation techniques. However,  some examples of practical de-escalation techniques and calming and reassuring strategies that social care professionals could adopt are as follows

• Start de-escalation immediately on recognising the first signs of irritation, agitation, anger or aggression and approach the person calmly.
• Use de-escalation techniques that have worked previously, as these can be more effective. They should be appropriate for the individual and the situation.
• Try distracting or redirecting them from the current situation, but be aware that this can escalate in some people, e.g. those with dementia.
• If face-to-face, maintain a safe distance to not encroach into the individual’s personal space and not appear to intimidate or threaten, and also for safety reasons.
• Validate the individual’s emotions by paying attention and actively listening to what they say without judgment. It does not mean validating their actions but understanding how they are feeling and why.
• Try not to inadvertently escalate the situation further, i.e. avoid confrontation, shouting, arguing, controlling, ordering and trying to reason. The aim is to make the individual regain a sense of control when they feel like they are out of control.
• When communicating with the individual, speak softly and pleasantly and use calming non‐verbal gestures and body language. Also, interpret their non‐verbal gestures and body language to assess how to respond.

Safety Planning

Some individuals experiencing crisis, especially those with mental health crises, may experience suicidal ideation and are at an increased risk of harming themselves and committing suicide. Therefore, safety planning is crucial, which is a “structured and proactive way to help people plan a range of activities and sources of support they can use at the right time to help them prevent or manage a developing crisis” (Oxford Health NHS Foundation Trust).

Safety planning in crisis intervention is important, as it helps individuals identify their triggers, warning signs and coping strategies to help them prevent or manage a developing crisis. A safety plan is a written plan that provides them with a series of steps to follow if they feel distressed or suicidal, which can help them regain a sense of control. Safety planning can have many benefits, such as:

• Enhanced mood and fewer negative mood states.
• A decline in suicidal ideation.
• A reduction in the number of suicide attempts.
• A lower risk of hospitalisation.

Social care professionals may be required to develop safety plans that address immediate risks, and they can achieve this by:

• Collaborating with the individual and/or their family and caregivers to provide person-centred care and to empower individuals in crisis to take control. The individual in crisis should ideally complete the plan with the support of the social care professional.
• Using an approved high-quality safety plan, such as the Stanley-Brown Safety Plan, will lead to better outcomes for patients/clients.
• Consider including the following in a safety plan:

• • How to recognise the warning signs of an impending suicidal crisis.
  • The situations or events that can result in low mood or suicidal ideation and past or present thoughts, feelings and events.
  • The coping strategies and actions to implement without needing to contact someone else.
  • Who they could contact, e.g. family, friends and acquaintances, to distract themselves from suicidal thoughts and urges without discussing these.
  • Which family and friends could they contact to discuss suicidal ideation, and who could help them resolve the crisis?
  • The method of contacting health and social care professionals when needed.
  • How to reduce the risk of self-harm and suicide by keeping the environment safe, e.g. disposing or removing anything that could cause harm.
  • Goals to improve mood, environment and self-care and how to achieve them.

Examples of safety plans are on:

• The Oxford Health NHS Foundation Trust.
• The Mersey Care NHS Foundation Trust.
• The Samaritans.
• Every Life Matters.

Collaborative Approach

Working collaboratively with others is known as a multi-disciplinary approach or integrated care. It is when various health and social care professionals come together to plan and coordinate an individual’s care. There will be many other professionals and agencies that social care professionals will collaborate with in crisis intervention to ensure an individual in crisis gets holistic and person-centred care. It also means including individuals in crisis and their families/caregivers.

Social care professionals typically work as part of a Crisis Resolution and Home Treatment Team (CRHTT) or Crisis Team for short, which may also include a team lead, psychiatrist, mental health nurse, pharmacist, and support workers. They may also collaborate with General Practitioners (GPs), Occupational Therapists, Psychologists, Crisis Intervention Team (CIT) Police Officers, Specialist Liaison Teams, Crisis Intervention Workers, etc. Each individual and their situation and crisis will vary. Therefore, the professionals involved in their care and support will also differ.

Working collaboratively with other professionals and agencies is valuable for the following reasons:

• Each health and social care professional brings their own expertise and skill set, which is essential in providing holistic and person-centred care.
• It allows for open and honest discussions about the needs of patients/clients and the care and support they need.
• It ensures timely, consistent, and appropriate crisis intervention, increasing coordination, organisation, productivity and efficiency.
• It reduces unnecessary admissions and hospital stays, as individuals can have care and support in their homes and communities.
• It reduces the risk of individuals having further crises and is an important part of preventive care.

Working as a team can enhance the effectiveness of crisis management as everyone is on the same page regarding an individual’s care and support. It also:

• Improves communication between health and social care professionals and leads to better decision-making.
• Enhances the working environment for staff, which can boost morale and satisfaction and support them to thrive.
• Allows for constructive criticism and alternative perspectives based on an individual’s needs, which can increase the team’s effectiveness.
• Reduces the risk of mistakes, miscommunication and conflicting information, advice and treatments that could result in adverse events.

Overall, a collaborative approach and effective teamwork can help provide high-quality, person-centred and improve patient outcomes for individuals in crisis by providing a supportive environment and helping them develop coping strategies.

Ethical Considerations

Crisis intervention is high-risk, unpredictable and fast-paced and can create numerous ethical dilemmas and difficult circumstances for social care professionals. They often have to make ethical decisions quickly, especially regarding confidentiality and patient/client autonomy.

Confidentiality

There are laws surrounding patient/client confidentiality, i.e. social care professionals must act with the informed consent of patients/clients, uphold confidentiality/privacy and share information appropriately.

Social care professionals may face ethical dilemmas regarding confidentiality where an individual in crisis puts themselves and others at serious risk and/or lacks the mental capacity to make decisions regarding sharing their information. The use of digital technology and social media can have additional implications.

Social care professionals must decide when and what information to share with other health and social care professionals, other agencies, such as the Police, and family and caregivers. They must only share information professionally when necessary and required by law while respecting an individual’s wishes and preferences. They should not disclose information without authorisation or justification.

It requires them to balance consent, confidentiality and privacy with safety and the care and support an individual needs.

Patient/client autonomy

Autonomy means providing competent individuals with the opportunity to make informed decisions about their medical treatment and care, and it is one of the central concepts in medical ethics (Taylor, 2018). Wherever possible, social care professionals should promote individuals’ autonomy, dignity and independence and support them to make informed decisions regarding their care.

Social care professionals may face ethical dilemmas regarding patient/client autonomy where they need to make crisis intervention decisions for the individual because:

• Of the risks to their safety and that of others.
• They are unable to make decisions for themselves.
• It conflicts with the rights of others.

It may require restrictive and deprivation measures for individuals in crisis, which can reduce their autonomy and liberty. For example, if there is a serious risk to themselves or others, it may require compulsory admission and detention under the Mental Health Act to protect them.

Social care professionals can navigate ethical challenges by:

• Following the relevant legal framework, social care standards and code of ethics.
• Identifying ethical dilemmas and getting additional support to address the issues, e.g. from supervision.
• Providing information to individuals in crisis, their families and caregivers about potential ethical dilemmas and what will happen if they arise, i.e. if there are safety risks, they may need to break confidentiality.
• Reporting unresolved significant dilemmas, e.g. complaints procedures and whistleblowing.

There is further information on ethical considerations on the following:

• Social Care Institute for Excellence (SCIE).
• The British Association of Social Workers (BASW).
• Social Work England.

Self-Care for Social Care Professionals

Even though social care is rewarding, it is not an easy profession, and those working in this role are at risk of anxiety, stress, exhaustion and burnout due to the emotional toll that crisis intervention can take, which has exacerbated since the COVID-19 Pandemic (Care Quality Commission). They will also have many demands, as they typically have several cases to work on and can develop compassion fatigue.

If a social care professional is experiencing burnout, they may:

• Be constantly fatigued and drained.
• Feel cynical and negative about their work.
• Feel detached, helpless and defeated.
• Feel overwhelmed, frustrated and irritable.
• Be lacking in energy and effectiveness.
• Have self-doubt.
• Procrastinate.
• Misuse substances.
• Have physical symptoms, e.g. trouble sleeping, headaches and stomach aches.

Burnout can lead to mental and physical health problems and also result in a lack of productivity and mistakes, which can be costly in crisis intervention. To truly help individuals in crisis, social care professionals must have good physical and mental health and well-being to care for their patients/clients competently. Therefore, they must adopt self-care to prevent burnout and promote well-being.

Self-care refers to the activities that social care professionals can undertake to look after their mental, emotional or physical health. The activities will differ from person to person, but they could:

• Plan and prioritise their workload, have good time management and be realistic about what they can accomplish. They should not be afraid to say no, as they cannot do everything. Employers also have a role to play in preventing stress and burnout.
• Speak to their colleagues who may also be able to provide advice and help them think more clearly. Family and friends can also be a great support network.
• Use supervision as an opportunity to self-reflect and raise concerns with their supervisor. It is also important for supporting and maintaining well-being.
• Understand the causes of stress and burnout (triggers), recognise the signs and symptoms and acknowledge that they are not feeling themselves. They should notice any issues early on and not wait until burnout occurs.
• Practice self-compassion, which means being kind, patient and understanding towards themselves and balancing and accepting negative emotions.
• Find ways to relieve their stress, such as.:
  • Relaxation techniques, e.g. mindfulness/meditation, progressive muscle relaxation, guided imagery, and breathing exercises.
  • Spend time outside in nature, e.g. forest bathing.
  • Do some Yoga, pilates or gentle stretching.
  • Spend time around animals, especially with pets.
  • Try self-help techniques, e.g. cognitive behavioural therapy (CBT).
• Start a new creative hobby, e.g. drawing, painting, sculpting, poetry, etc.
• Try journaling, i.e. writing down feelings and thoughts.
• Have time for themselves without feeling guilty, and ensure they have regular breaks and days off to return refreshed, energised and reconnect with their work. Having a good work-life balance is essential.
• Have a healthy lifestyle, e.g.:

• • Eat a healthy and balanced diet and drink plenty of fluids, especially water.
  • Get plenty of exercise, e.g. jogging, cycling, walking and sports.
  • Relax before bedtime and get plenty of sleep.
  • Avoid alcohol and drugs and reduce caffeine intake.

• Seek help from other professionals, and never be embarrassed or worried about needing support. Some employers have employee well-being support services that provide counselling and peer support. There is also assistance from:
  • Regulatory bodies, such as Social Work England.
  • Professional bodies and associations, such as the British Association of Social Workers.
  • Mental health charities, such as the Samaritans, Shout 24/7 and Mind.
  • Other organisations, such as Community Care Inform.

Practising self-care will enable social care professionals to become more resilient and improve their overall health and well-being.

Conclusion

Anyone can experience a crisis. When it happens, individuals must get the help and support they need. Crisis intervention, although a short-term service, provides immediate stability for patients/clients, helps them find coping strategies to prevent further crises and empowers them to take control of their own lives. Overall, it positively impacts individuals and communities.

Social care professionals are integral in crisis intervention and help individuals from all walks of life. They will use a person-centred and holistic approach while collaborating with other healthcare professionals and agencies to provide the best possible care for individuals. They must practice self-care, as crisis intervention can have an emotional toll and increase the risk of stress, burnout and mental health issues.

As crisis intervention is challenging and social care professionals can face ethical dilemmas and difficult situations, it is vital for them to continuously develop their crisis intervention skills and seek additional training and support when necessary. A lack of competency can be serious in this health and social care area and can put individuals in crisis, social care professionals and others at risk of harm.

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