Crisis and opportunity
Crisis has many risks but it is also an opportunity to open up new possibilities. It may also be a time when someone is able to speak of issues that are troubling them that they are usually either unable or unwilling to talk about.
Crisis and control
Crisis is a time of heightened emotion and uncertainty for everyone involved. Against this backdrop, the person at the centre of the crisis may find themselves losing control of their situation, especially when other people take control. Often crisis responses are driven by a desire to keep someone ‘safe’. However, what makes one person feel safe, such as having family members around or being locked in, may make another person feel unsafe. Supporting someone to take back control can be challenging when they are in great distress, suicidal, asking others to take control, or in an environment where control is vested in other people, such as in hospital. Responses to crisis that emphasise external control rather than collaboration can unwittingly traumatise people.
The person in crisis needs to be in control of responses to their crisis as much as possible. This may include crisis planning and advocating for their involvement in decision-making in environments where they may not otherwise be listened to. Clear communication about caregiver responsibilities and limits is essential. For example, it is important to be clear about the caregiver’s availability, the need to involve others, and what someone might do if key supports are not available when needed.
The importance of relational safety
It’s useful to have a conversation about what safety means for the individual. Discussions about risk and safety are most effective in a transparent, trusting relationship that fosters collaboration and open dialogue, and is not focused on rules and restrictions. This can be thought of as relational safety—when people who use services feel safe in their relationships with workers, and the workers can take more risks, such as asking challenging questions, trying something new or expressing disagreement.
It’s easier to plan and make decisions about a crisis situation when someone is not currently in a crisis. People commonly believe that they will never be in crisis again, so they may be reluctant to plan for another one. However, the process of crisis planning can be useful, even when there isn’t another crisis, as it opens up discussions on experiences, fears and possibilities, as well as the factors that influence mental wellbeing. Crisis planning is proven to increase a person’s control in a crisis. When planning for a crisis, it’s useful to articulate both what someone does and doesn’t want. It may also be useful to involve people close to them.
There are many tools to suit different people and circumstances, for example:
- Advance statements and advance directives are recognised in the law and tend to focus predominantly on treatment and medication issues, although in many jurisdictions they may include anything that is useful for the person, such as instructions for childcare or paying bills.
- Mad maps are a creative, social-justice-oriented approach to exploring self-determined wellbeing, various ways to navigate crises, and personal and social transformation.
- Wellness recovery action plan (WRAP). This is an evidence-based wellness-planning tool used in many different settings—from facilitated WRAP groups to a mobile phone app.
Advance health directives (Australia):
Advance statements in mental health (Victoria, Australia):
Advance directives in mental health (New Zealand):
WRAP: Wellness Recovery Plan
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The Copeland Centre, ‘Wellness recovery action plan’, viewed 30 May 2015, http://www.mentalhealthrecovery.com.
Farrelly, S., Brown, G., Rose, D., Doherty, E., Henderson, R.C., et al., 2014, ‘What service users with psychotic disorders want in a mental health crisis or relapse: Thematic analysis of joint crisis plans’, Social Psychiatry Psychiatric Epidemiology, vol. 49, pp. 1609–17.
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