On the show today we talking all about de-escalating a mental health crisis and how with just a few basic skills and strategies you will be able to support a person who is in crisis while maintaining good rapport.
I want to start by recognizing that when I’m referring to a mental health crisis. This is a subjective term. For one person this could be suicidality and for another, this could be struggling to cope and having a panic attack. I want to validate both experiences. A mental health crisis for one person can look completely different from another.
PODCAST LINKS:
Free Download: 4 stages of a crisis cheat sheet
Vlog video: Flipping Your Lid
Resource for Developing Policies: Abuse Suicidality
Episode 10: What to say when you don’t know what to say
We need to approach a crisis situation with compassion recognizing that we have likely ALL been emotionally dysregulated in public before. Doesn’t matter if it was frustration at line-ups, traffic, anger at a belligerent person or overcome with grief or fear.
Experiencing a crisis, or being seen at our worst in public is an awful feeling that most of us can empathize with.
The person who is overwhelmed or having an outburst is a child of God. A neighbour, sister, father, coworker and friend. No variance of ability, cognitive abnormality, or behavioural choice will change that they are precious to God and so our response to that person ought to be one of compassion and respect.
If we are the leader of the group, or the neighbour sitting beside a person who is decompensating it can feel like we are helpless, out of control or to be honest it can be scary if the person is loud, acting strange or verbalizing threats to themselves or others.
But it is possible to care for that person, while at the same time recognizing that safety is the priority. I have been in situations where the person was apprehended by police and hospitalized against their will, but because of the compassion and respect offered at the moment, the relationship was maintained.
SAFETY
The safety of the person, yourself and bystanders are the priority. If you feel that someone might get hurt. Either because of suicidal behaviour, they are aggressive towards you or by-standards are in harm’s way. The need to keep people safe trumps the need to maintain the relationship. And we will walk through these circumstances later on.
As mentioned before, as a leader, care provider if someone is experiencing a crisis it can evoke a lot of emotions within you.
It can make you nervous, hesitant because you don’t want to make things worse or unsure of what you should do to help. Do you leave the large group and go after the individual struggling? What do you say when you find them?
It can be overwhelming. Not only are you balancing the responsibilities of others, but how do you manage the high needs of this one individual. And if you have had a negative experience in the past this could be very triggering for you as well.
Your instinct might be to react or to be protective. Causing you to overreact, escalating the situation or acting in a punitive nature causing harm to the relationship and sending the message that your church isn’t a safe place.
It’s important to recognize that as caregivers we are humans too and a crisis response from someone else can evoke a response in us. This is why having emotional intelligence as caregivers and leaders is so important. Having awareness of our own emotions and how we are triggered, so that we have the ability to handle high-risk interpersonal situations.
FLIPPING YOUR LID
I want to introduce a concept called flipping your lid, by Dan Siegel. This is a simplified explanation that I borrow to describe what happens in the brain when people experience stress. It’s a simple way to learn about what happens when we feel emotionally and physically threatened.
I think this will be very helpful as it provides a context in which we will discuss our supportive skills.
If you hold up your fist with your thumb tucked under your fingers it is a visualization of the brain.
The front of your fingers are the pre-frontal cortex or logic center of the brain. The back of your hand or wrist is your brain stem or the area that is in charge of all the automatic system functioning, like breathing and heart rate. Your thumb that is tucked in your fist is called the amygdala. This is part of the brain that senses danger and alerts the rest of the brain and triggers the fight, flight, freeze and fawn responses.
Normally the front logic center is in charge. It processes, analyzes and assesses. However, the job of the amygdala to sense danger. If it feels threatened then it takes over and your flip your lid. Demonstrated by opening your fist exposing your thumb. You are no longer operating primarily out of your logic center but with your amygdala and the fight, flight and freeze and fawn mode are fully engaged.
This happens to everyone, the person experiencing a crisis and you.
Those who have flipped their lid are often are responding with a lot of emotions and having a physical response. The amygdala is sending signals for your heart to pump hard and face, to prepare your muscles for action and to be alert watching for threats.
4 STRESS RESPONSES
Fight response is designed to defend ourselves from danger.
Flight’s response uses the extra energy made available to escape the traumatic experience. There’s a strong urge to get out or leave the situation.
Freeze is a survival reaction where the body is temporarily immobilized or numbed. Muscles can be tight, ready for action, but you can feel paralyzed. A common description is a feeling of overwhelm. Being flooded with stimulus, but frozen not knowing what to do,
Fawn,or ‘submit, is lesser know’. This response happens when survival is dependent on placating or appealing the aggressor. For example, in hostage situations, childhood abuse, sexual trauma, domestic abuse.
I need to have a disclaimer here and say that the knowledge I’m sharing is coming from working with people for the past 15 years who experience mental health crises’. As well as the many trainings I have attended. I feel confident in the information I’m sharing but I am not an expert trainer in high-risk, violent crisis situations.
If you are wanting to create policies around the crisis issues of child abuse, suicidality, or weapons threats. I would recommend connecting with specialists (see above)
A comprehensive organizational policy for crisis prevention would consider prevention strategies, intervention practices and postvention pathways.
But for the purpose of the podcast, the 4 stages of crisis behaviour that I’m sharing is a high-level overview of prevention, intervention and postvention. And while it offers a great place to start in creating, policy and procedures it is not comprehensive.
4 STAGES OF CRISIS BEHAVIOUR AND DE-ESCALATION STRATEGIES
Once you learn these stages you will begin to see it everywhere. The frustrated customer, angry neighbour, the exhausted parent. These stages of crisis show how human emotions escalate and how we support and de-escalate.
1. Agitation
Agitation is seen as a noticeable change in the person’s behaviour. 
The signs and symptoms will be familiar because they are virtually the same symptoms we discussed with flipping your lid. People’s body language changes. Just like in a fight response voices grow louder or start talking fast. Their face may be red and sweating and Hands and legs are restless and people may feel the need to move and pace. But also, people can avoid eye contact or even isolate themselves from a group. Kinda like a flight response
These are the first signs that they are not doing well. Ideally, intervention at this stage will prevent further escalation.
You can help de-escalate by:
First, knowing those in your community and being able to identify when there is a change of behaviour.
Secondly, you can let the person know that you care and offer support using those strong active listening skills.
Thirdly you can help them find ways to help manage the stress they are experiencing. These activities don’t need to be complicated. They can be as simple as listening to music, walking, reading, doing puzzles, watching comedy, or talking it through.
In a moment of crisis, the goal is to allow the body time to calm and re-engage the logic center and to deescalate the moment. It is not the time to counsel or problem-solve, as that often agitates the person further.
2. combative
In the combative stage, the individual may lose rational thought and can become belligerent and often challenges authority.
You can help de-escalate by:
When they are in this stage it’s helpful to give them time and space to vent. They are releasing energy and it’s better to allow them to release their frustrations by venting than containing it and it escalates to a physical reaction.
If possible you need to remove the audience and anything or anyone that might provoke them further.
Setting limits in this stage are needed. Although, allowing people to blow off steam is beneficial. By setting limits and giving people options of what they can do to control their behaviour and you identify what is acceptable and unacceptable. Clearly communicate the consequences of their behaviour using simple language and short sentences.
3. Aggression
In this stage, you will see a total loss of rational control and people become physically violent to either property or to people.
You can help de-escalate by:
It is very important that you do NOT physically intervene, but call emergency services. Ensuring that you and other bystanders(if unable to be removed) remain safe is the #1 priority.
4. De-escalation
In this stage, people begin to regain rational control and are able to discuss the issue. They often verbalize or show signs of remorse for their actions and are embarrassed. Because of the huge amount of emotional and physical energy just released, people are often tired and lethargic.
You can help support by:
As supporters, we have a great opportunity to offer compassion and to build trust. By first offering the person grace, you as a supporter, build trust that will allow you to have the opportunity to discuss and reflect at a more appropriate time.
Crisis’ can occur anywhere. During a support session, in the classroom or meetings or even at an event.
The ideal situation is that you will recognize when someone is not doing well or has flipped their lid. It is then that you can de-escalate them, preventing a crisis. But using active listening and validation.
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