CRISIS INTERVENTION

INTRODUCTION

DEFINITION
According to Caplan (1964)
“… Psychological disequilibrium in a person who confronts a hazardous
circumstance that for him constitutes an important problem which he can for the
time being neither escape nor solve with his customary problem solving
resources”. A
A crisis is defined as a point that requires a change in the usual method of
functioning. The change requires adaptation, learning and growth.
Crisis intervention refers to the methods used to offer immediate, short-term help
to individuals who experience an event that produces emotional, mental, physical,
and behavioral distress or problems. A crisis can refer to any situation in which
the individual perceives a sudden loss of his or her ability to use effective
problem-solving and coping skills. A number of events or circumstances can be
considered a crisis: life-threatening situations, such as natural disasters (such as
an earthquake or tornado), sexual assault or other criminal victimization; medical
illness; mental illness; thoughts of suicide or homicide; and loss or drastic
changes in relationships (death of a loved one or divorce, for example).

Difference Between Stress & Crissis

Stress :
 Stress is a feeling that's created when we react to particular events.
 Is it primarily an external response that can be measured by changes in
glandular secretions, skin reactions, and other physical functions, or is it
an internal interpretation of, or reaction to, a stressor; or is it both.
 A state of affair involving demand on physical or mental energy". ( According
to oxford dictionary )
 A condition or circumstance (not always adverse), which can disturb the
normal physical and mental health of an individual.
 In medical parlance 'stress' is defined as a perturbation of the body's
homeostasis.
 Stress, nonetheless, is synonymous with negative conditions.
Crisis :
 In a crisis an imbalance occurs that results in confusion & disorganization.
 An active crisis state may last 4-6 weeks.
 A person is confronted with an overwhelming threat & cannot cope.
 The person will either adapt at this point & develop new coping skills OR
decompensate (not adapt) to a lower level of functioning.

Causes of crises
Crises are more common in those with severe mental illness and personality
disorders. There are many potential causes of a crisis, including:
  Adolescence
 Menopause
 Retirement
 Redundancy
 Becoming homeless
 Changes of role, e.g. getting married, having a child, more demanding job
 Relationship problems, e.g. with partners or child
 Conflict: usually due to a difficult choice where neither alternative is acceptable
 Serious injury or loss of a limb
 Bereavement
 Post traumatic stress
 Non-compliance with medication in someone with pre-existing severe mental illness

PHASES IN THE DEVELOPMENT OF A CRISIS

The development of a crisis situation follows a relatively predictable course.
Caplan (1964) has outlined four phases through which individual progress in
response to a precipitating stress or and which culminate in the state of acuts
crisis.
Phase I - The person has an increase in anxiety in response to a traumatic event
if the coping mechanisms work, there’s no crisis  if coping mechanisms do not
work (are ineffective) a crisis occurs.
Phase II: When previous problem – solving technique do not relieve the stress or,
anxiety increase further : The individual begins to feel a great deal of discomfort
at this point.
Phase III :
*All possible resources, both internal and external are called upon to resolve the
problem and relieve the discomfort : The individual may try to view the problem
from a different perspective or even to over look certain aspects of it. New problem
solving techniques may be employed and if effectual resolution may occur at this
phase.
*Anxiety continues to increase & the person asks for help. (If the person has been
emotionally isolated before the trauma they probably will not have adequate
support & a crisis will surely occur).
Phase IV – Is the active crisis – here the persons inner resources & supports are
inadequate. The person has a short attention span, ruminates (goes on about it),
& wonders what they did or how they could have avoided the trauma. Their
behavior is impulsive & unproductive. Relationships with others suffer  they
view others in terms of how can they help to solve the problem. The person feels
like they are losing their mind  this is frightening – Be sure to teach them that
when the anxiety decreases that thinking will be clearer.

TYPES OF CRISIS :There are 4 types of crisis :

a) Maturational Crisis
b) Situational Crisis
c) Adventitious Crisis
d) Socio-cultural Crisis
a . MATURATIONAL CRISIS:
Development psychology describes a series of steps that must be taken in growing
towards maturity. During this process the transitional periods between stages can
upset psychological equilibrium.
Maturational crisis are developmental events requiring role changes. For eg :
successful progression from early childhood to middle childhood requires the
child to become socially involved with people outside the family with the more
from adolescence to adulthood, financial responsibility in expected. Both social
and biological pressure to change can precipitate a crisis.
The nature and extent of the maturational crisis can be influenced by role
models, interpersonal resources, and the case of the other sin accepting the new
role. Positive role models show the person how to act in the new role.
Interpersonal sources encourage the training out of new behaviour to active role
changes.
Transitional period during adolescence, parenthood, marriage, midlife and
interment are key times for the onset of maturational crisis.
b . SITUATIONAL CRISIS :
Situational crisis occur when a life event upsets an individual or groups
psychological equilibrium eg : loss of job, loss of loved one, unwanted pregnancy,
onset or worsening of a medical illness, divorce, school problems & witnessing a
crime etc.
A situational crisis is a response to a traumatic event that is usually sudden &
unavoidable.
It usually follows the loss of an established support or role.
The threat or loss of a role viewed as necessary to maintain self-image usually will
lead to a crisis state.
Situations that affect the way people perceive themselves include loss of a job,
failure in school, loss of a spouse, birth of a retarded child, or diagnosis of a
terminal or chronic illness.
c . ADVENTITIOUS CRISIS :
These crisis are accidental, uncommon and unexpected events. Multiple losses
with major environmental changes result. Eg : fires, earthquakes, hurricanes or
floods, which disrupts, entire community and are adventitious crisis.
Unlike maturation and situation crisis, adventitious crisis do not occurs in the
lives of everyone. When they do occur they challenges every coping mechanism
because of the severity of the stress.
If the reconstruction phase does not begin with in 6 months after disaster. The
likelihood of lasting psychological problems is greatly increased.

d . SOCIO-CULTRUAL CRISIS:
Social crisis is one arising from the cultural values that are embedded in the
social structure.
Eg : The loss of job stemming from discriminatory practices based on age, race,
sex, sexual preference or class is a primary example of a socio-cultural crisis.
They type of job loss various markedly from job loss due to illness or poor
performance, additionally. Crisis that relate to deviant acts of others whose
behaviour violates social norms, such as robbery, rape and incest, may be
classified as socio-cultural crisis.
Crisis from socio-cultural sources are generally loss amenable to control by
individuals. Very often, cultural views & public social policies may be a
component of either the identification or the resolution of these crisis. Whenever
the crisis originates outside the individual, it is usually beyond the ability of the
individual alone to control and manage.

CRISIS THEORY
Baldwin’s ten corollaries to crisis theory.
1.Each individuals tolerance for stress is idiosyncratic and finite. Emotional crisis
have no relationship to psychopathology and occur over among the well adjusted.
2.Emotional crisis are self limiting events in which crisis resolution either
adaptive or maladaptive.
3.During a crisis state psychological defenses are weakened or absent, and the
individual has cognitive or affective awareness of issues and memories previously
well defended against & less accessible.
4.During a crisis state the individual has enhanced capacity for both cognitive
and effective learning because of the vulnerability of the state and the motivation
produced by emotional equilibrium.
5.Adaptive crisis resolution is frequently a vehicle for resolving conflicts.
6.A small external influence during crisis state can produce disproportionate
change in a shorter period than therapeutic change that occurs during non-crisis
state.
7.Resolution of emotional crisis is not necessarily determined by previous
experience or character structure.
8.Internet in every emotional crisis is an actual or anticipated loss to the
individual that must be reconciled as part of the crisis resolution process.
9.Every emotional crisis is an interpersonal event involving at least one significant
other person who is represented in the crisis situation directly, indirectly/
symbolically.
10.Effective crisis resolution prevents similar future crisis

Aguilena’s paradigm : The Effect of balancing factors in a stressful event.

Human Organism
CRISIS INTERVENTION
Aguilena believes that, Crisis intervention can offer the immediate help a person in crisis needs. It is
an expensive short term therapy focused on solving the immediate problem and it is usually limited
to 6 weeks.
The goal of crisis intervention is for the individual to return to a pre crisis level of functioning often
the Person advances to a level of growth that is higher than the pre crisis level because new ways of
problem solving have been learned.

PURPOSE OF CRISIS INTERVENTION :

To reduce the intensity of an individual's emotional, mental, physical and
behavioral reactions to a crisis.
Another purpose is to help individuals return to their level of functioning before
the crisis.
Helps to cope with future difficulties.
Crisis intervention aims to assist the individual in recovering from the crisis and
to prevent serious long-term problems from developing.
The person becomes more willing to try new ways of problem solving (including
professional help)  and this results in growth.

The 8 Elements of Crisis Intervention

Education.
There is a natural ability within  most people to recover from a crisis provided
they have the support, guidance and resources they need. The very heart of crisis
intervention is to face the impact of a crisis. In most cases, a crisis involves
normal reactions, which are understandable, to an abnormal situation. An
effective crisis counseling provides information, activities and structure that will
help us recover and move past the crisis. More importantly, crisis counseling will
insure that you do not prolong a crisis and it will help insure you do not create
more problems in your life and the lives of others. Confrontation through
information and discussion may be an important part of crisis intervention.
 
Observation and awareness. A crisis in our life can be the result of low self-
awareness or not recognizing the impact our behavior has on others as well as the
impact it has on our self. Increasing your awareness can lead to choices that
promote recovery and wellness. You can't help yourself if you cannot see the
problem and how you may be contributing to the crisis. In some cases, family
dynamics and communication problems within families can prolong a crisis

Discovering and using our potential. Every crisis represents an opportunity for
personal growth and to discover our highest potential and true self.  The greatest
hero in any crisis is the person who does not believe he or she is a hero, but is
never-the-less prepared for the challenge by the undiscovered qualities and
abilities that are only discovered when we are facing tragedy and the "inevitables"
of life. While support is important, this does not mean that the person in crisis
should not be allowed, encouraged and sometimes required to make decisions
and take action to resolve the crisis and improve the quality of their life.
Understanding our problems. It is the fundamental intention of all people to do
the best they can with the resources and abilities they have during a crisis.
During any crisis, it is important to recognize or discover our true and deepest
intention. You must keep your intentions in mind no matter what you do or how
unskillfully you may act. While our intent is usually to make life better, our
behavior can be misguided, misunderstood and less effective than we would
hope. Self-understanding as well as understanding how others may keep us
"stuck" are important keys to recovery.

Creating necessary structure. The most important aspect of crisis intervention

and counseling is to provide a social "container" for our experience that will allow
us to express, explore, examine and become active in ways that help insure the
crisis is not prolonged. For each of us, there are necessary activities and routines
in our life during times of distress that provide comfort and support. These do not
include alcohol, medications or other drugs. Medications should only be used to
prevent a physical or psychological breakdown. The purpose, duration, frequency
and potential impacts of medications must be defined in order to make informed
decisions.

Challenging irrational beliefs and unrealistic expectations. Few people, during

times of crisis, have the necessary skills to fully examine what they are thinking,
what they assume and what they expect from their self and from others. Our
thoughts, especially the ones we don't look at, contribute a great deal to how we
feel and what we do next in response to our feelings.
 
Breaking vicious cycles and addictive behavior. Many crises are the result of
vicious cycles or addictions. For example, drug and alcohol use can not only
destroy our life, but it will confuse how we actually feel about our self, others and
the world around us. One cannot know how they feel and what they truly want if
their feelings are modified by chemicals, medications, alcohol and other drugs. A
painful crisis can lead a person to avoid and escape how they feel. Unhealthy
escape and avoidance of emotional pain and distress may involve the use of
medication, drugs, alcohol, sex, thrill seeking, parties or working excessively.
Taking the role of a "victim" can cause others to rescue a person in crisis.
Prolonging the crisis by refusal to deal with a crisis can create supportive
relationships. When a person becomes dependent on others and "escapes" to feel
better, a vicious cycle can develop. Vicious cycles start with behaviors that are
intended to avoid or escape emotional pain, but ultimately these avoidance and
escape behaviors create more problems or the same problem we are trying to
avoid. The behaviors found in a vicious cycle can actually prolong a crisis.  

Create temporary dependencies. During a crisis, it is often helpful to form brief

relationships with others in order to gain support. Crisis counseling and
intervention are very helpful and necessary.  A healthy dependency is usually
temporary and will always lead to increasing independency. Unhealthy
dependencies are long term and create increasing dependency rather than
independency.
Facing fear and emotional pain. A crisis is usually a time of fear or sadness.
How we respond is important. There is "monster" in the world for every person
who "runs" in response to their fear or sadness.  When we face the darkness in
our life, and we are not destroyed by our fears, or sadness, we eventually discover
there are no monsters. We discover that  we can survive. In time we discover that
our pain will fade. Facing emotional pain is the most healthy response. This does
not mean we should make our self miserable. But we should not expend a great
deal of energy and become involved in activities that help us avoid how we feel
and what we think. When people suffer, it is important to help them feel less
alone in the world. It is important to help people in crisis solve the problems in
their life. People in emotional pain need to be empowered and supported.

Description About Crisis Intervention

Individuals are more open to receiving help during crises. A person may have
experienced the crisis within the last 24 hours or within a few weeks before
seeking help. Crisis intervention is conducted in a supportive manner. The length
of time for crisis intervention may range from one session to several weeks, with
the average being four weeks. Crisis intervention is not sufficient for individuals
with long-standing problems. Session length may range from 20 minutes to two
or more hours. Crisis intervention is appropriate for children, adolescents, and
younger and older adults. It can take place in a range of settings, such as
hospital emergency rooms, crisis centers, counseling centers, mental health
clinics, schools, correctional facilities, and other social service agencies. Local and
national telephone hotlines are available to address crises related to suicide,
domestic violence, sexual assault, and other concerns. They are usually available
24 hours a day, seven days a week .

CRISIS INTERVENTION & AND ROLE OF NURSE

Crisis intervention includes 4 steps :
a) Assessment
b) Planning and implementation
c) Therapeutic intervention
d) Evaluation
( a ) ASSESSEMENT :
The 1st step of crisis intervention is assessment. At this time data about the
nature of the crisis and its effect on the patient must be collected, more
significant and long standing problems may be identified by the nurse. During
these phase the nurse begins to establish a positive working relationship with the
patient. A number of specific areas should be assessed, these factors are
important in the development and resolution of a crisis that includes :
 Balancing Factor
  Precipitating event/ stressor
 Patient’s perception of the event/stressor
 Nature and strength of the patient’s support system and coping resources
 Patient’s previous strength and coping mechanisms.

Balancing Factor :
Balancing factors are important to assess because they affect the way an
individual perceives and responds to a precipitating stress or the assessment of
balancing factors includes perception of the events. Situational support coping
mechanisms.
Precipitating Event :
To help, identify the precipitating event the nurse should explore the patient’s
needs, the events that threat in those needs, and the time at which the
symptoms appear. Four kinds of needs that how been identified are related to
self-esteem, role mastery, dependency and biological function.
Self esteem is achieved when the person attains successful social role experience.
Role mastery is achieved when the person attains, vocational, sexual, family role
successes.
Dependency is achieved when a satisfying inter dependent relationship with other
is attained.
Biological function is achieved when a person is safe and life is not threatened.
The nurse determines which needs are not being met by asking the patient, she
looks for obstacles that might interfere with meeting the patients needs what
recent experiences have been upsetting? What areas of life have had changes?
When did the patient begin to feel anxious.
Perception of the event :
Patient’s perception or appraisal of the precipitating event is very important. Eg :
(1) An Over weight adolescent girl may been the only girl in the class not invited
to a dance. This may have threatened her self esteem.
Eg (2) A Man with two unsuccessful marriage may have just been told by a
girlfriend that she wants to end their relationship, this may have threatened his
need for sexual role mastery.
Eg (3) An emotionally isolated, friendless women may have had car trouble and
been unable to find someone to give her a ride to wook. This may have threatened
her dependency need.
Eg (4) A chronically ill man who has had a recent relapse of his illness may have
had his need for biological function threatened.
Themes and surfacing memories of the patient gives further dues to the
precipitating event. Because most crisis involve losses or threats of losses, the
theme of the loss is a common one. In assessment the nurse looks for a recent
event that may be connected to an underlying theme.
Support System & Coping Resources
The patients living situation and supports in the environment must be assessed.
Does the patient live alone or with the family? Is there a supportive friend?
Assessing the patients support system is important in determining who should
come for the crisis therapy sessions. Assessing the patients coping resources is
also vital in determining whether hospitalization would be more appropriate than
outpatient crisis therapy eg: High degree if suicidal and homicidal risk with weak
outside resources.
Coping Mechanism
In this step the nurse assess the patient’s strengths and previous coping
mechanisms. How has the patient handled other crisis? How were anxiety
relieved? Besides exploring the previous coping mechanisms, the nurse should
also note the absence of other possible successful mechanisms.
b . PLANNING AND IMPLEMENTATION :
The next step of crisis intervention is planning; the previously collected data are
analyzed and specific interventions are proposed. Alternative solutions to the
problems are explored, and steps for achieving the solutions are identified. The
nurse decides when environmental supports to engage or strengthen and how to
do this, as well as which if the patient’s coping mechanisms to develop and which
to strengthen.
This process is outlined in the patient education plan for coping with crisis. The
expected outcome if the nursing care is that the patient will recover from crisis
event and return to a pre crisis level of functioning and improved quality of life.
C. THERAPEUTIC INTERNATION :
It can take place on many levels using a variety of techniques. There are four
levels of crisis intervention that represent a hierarchy from the most basic to most
complex. Each level incorporates the interventions of the preceding level and the
progressive order indicates that the nurse needs additional knowledge and still for
HighlevelofInterventions.

Individual Approach

Generic Approach

General Support

Environmental Manipulation

Levels of crisis intervention

ENVIRONMENTAL MANIPULATION:
It includes interventions that directly change the patients physical or
interpersonal situation. These interventions provide situational support or remove
stress. Important elements of this intervention are mobilizing the patients
supporting social systems and serving as a liaison between the patient and social
support agencies.
GENERAL SUPPORT :
General support includes interventions that convey the feeling that the nurse is
on the patients side and will be helping person. The nurse uses warmth,
acceptance, empathy, caring and reassurance to provide this type of support.

GENERIC APPROACH :
The generic approach is designed to reach high – risk individuals and large group
as quickly as possible. It applies a specific method to all people faced with a
similar type of crisis. This intervention is set up to ensure that the course of the
crisis results in an adaptive response.

INDIVIDUAL APPROACH :
The individual approach is a type of crisis intervention similar to the diagnosis
and treatment of a specific problem in a specific patient. The nurse must
understand the specific patient characteristics that led to the present crisis and
most use the intervention that is mot likely to help the patient develop an
adaptive response to the crisis. This type of crisis intervention can be effective
with all types of crisis.

Techniques Used in Intervention :

The nurse uses techniques that are active, focal and explorative to carry out the
interventions. The intervention must be aimed at achieving quick resolution. The
nurse should be creative and flexible, trying many different techniques, includes:
abreaction, clarification, suggestion, Manipulation, reinforcement of behaviour,
support of defenses, raising self-esteem and exploration of solutions.

Abreation :
It is the release if feelings that takes place as the patient talk about emotionally
changed areas. As feelings about the events are realized, tension is reduced. The
nurse encourages abreaction by soliciting the patients feeling about the specific
situation, recent events, and significant people involved in the particular crisis.
The nurse asks open ended questions and repeats the patients words so that
more feelings are expressed. The nurse does not discourage crying or angry
outbursts but rather sees them as a positive release of feelings.

Clarification:
Is used when the nurse helps the patient to identify the relationship between events, behaviour and
feelings clarification helps the patient gain a better understanding of feeling and how they lead to
the development of a crisis.

Suggestion :
Is influencing a person to accept an idea or belief. In crisis intervention the
patient is influenced to see nurse as a confident, calm, empathic person who can
help By believing the nurse can help the patient may feel more optimistic and less
anxious.
Manipulation :
Is a technique in which the nurse uses patient’s emotions, wishes, or values to
their benefit in the therapeutic process. Like suggestion, manipulation is a way of
influencing the patient.

Reinforcement Of Behaviour :
It occurs when healthy, adaptive behaviour of the patient is reinforced by the
nurse, who strengthens positive responses made by the patient by agreeing with
or complementing those responses.

Support Of Defenses :
It occurs when the nurse encourages the use of healthy defenses and discourages
those that are maladaptive. Defenses mechanisms are used to cope with stressful
situations and to maintain self esteem and ego integrity : The nurse should
encourage the patient to use adaptive defenses and discourage those that are
madaptive.

Raising Self - esteem :

It is a particularly important technique. The patient in a crisis feels helpless and
may be over whelmed with feelings of inadequacy. The nurse should help the
patient regain feelings of self-worth by communicating confidence that the patient
can participate actively in finding solutions to problems.

Exploration Of The Solution :

Is essential because crisis intervention is geared toward solving the immediate
crisis. The nurse and the patient actively explore solutions to the crisis.

MODALITIES OF CRISIS INTERVENTION

Crisis intervention modalities are based on the philosophy that the health care
team must be aggressive and go out to the patient’s rather than wait for the
patients to come to them.

MOBILE CRISIS PROGRAMS :

Mobile crisis teams provide front line inter disciplinary crisis intervention to
individuals, families and communities. The nurse who is a member of a mobile
crisis team may respond to a desperate person threatening to jump off a bridge in
a suicide attempt, an angry person who is becoming violent toward family
members at home etc.
Mobile crisis programs throughout the country vary in the service they provide
and the procedures they use. However, they are usually able to provide on site
assessment. Crisis management, treatment, referral and educational services to
patients families, law enforcement offices, and the community at large.

GROUP WOOK :
Crisis groups follow the same steps that individual intervention follows. The
nurse and the group help the patient solve the problem and reinforce the patients
new problem solving behaviour. The nurses role in the group is active, focal and
present oriented. The group follows nurses example and uses similar therapeutic
techniques. The group acts as a support system for the patient and is therefore if
particular benefit to socially isolated people.
Most crisis groups focus on people who have common traits of stressed, the most
significant aspects of the group work were the venting of feelings and the support
for healthy future response.

TELEPHONE CONTACTS :
Crisis intervention to sometimes practiced by telephone rather than through face
to face contacts. Listening skills must therefore be emphasired in the nurses role.
Manuals written for the crisis worker includes contact such as suicide potential
rating scales. Community resources, drug information, guidelines for helping the
calles discuss concerns and advice on understanding the limitations of crisis
workers’ role.

DISASTER RESPONSE :
As a part of the community, nurses are called on when adventitious crisis strike
the community floods, earthquakes, air plane crashes, fires, nuclear accidents
and the natural and unnatural disaster. It is important that nurses in the
immediate post disaster period go to places where victims are likely together,
such as mortgrues, hospitals and shelters.
Nurses providing crisis therapy during large disaster use the generic approach to
crisis intervention. So that as many people as possible can receive help in a short
amount of time.

VICTIM OUTREACH PROGRAMS :

Crime has become a loyal issue, concerning people in every walk of life and in
every country. Many victim outreach programs use crisis intervention techniques
to identify the needs of the victims and than to concept them with appropriate
referrals and other sources.
Crisis intervention is successful in the acute phase of rape. It uses an integrated
frame work of outreach, emergency care and advocacy assistance. These victims
need through evaluation, empathic support, information and help with the legal
system. The objective of crisis intervention are to validate the crisis and criminal
nature of the rape, identify a supportive social network, and self enhancing ways
of solving problems.
The nurses validation of and response to people in abusive relationships is one
component of a unified community wide response that is headed by local
domestic violence programs in many

CRISIS INTERVENTION TEAM PROGRAME

The Crisis Intervention Team program is a community effort enjoining both the
police and the community together for common goals of safety, understanding,
and service to the mentally ill and their families. It is to these goals the Memphis
Police Department stands committed.

The CIT program provides an avenue for the development of community

partnerships and the collaboration of working together for community interest of
service and care. CIT is about doing the right thing for the right reasons. CIT
recognizes a special population that deserves special care, treatment, and service.
CIT is not about fame, fortune, nor glory, but rather, one of honor and service.
narcotic/alcohol abuse and the “deinstitutionalzation” of mentally ill citizens has
caused many to become homeless and potentially more violent which increases
the chances of involvement with law enforcement.
As an innovative program, the CIT model encourages communities, families, law
enforcement officers, and mental health professionals to act as a compass for
consumers of mental illness.
Traditional police methods, misinformation, and a lack of sensitivity cause fear
and frustration for consumers and their families. Too often, officers’ respond to
crisis calls where they felt at a disadvantage or were placed in a no-win situation.
Unfortunately, it is usually after a tragedy that police departments look for
change. As a proactive program, CIT acts as a model committed to preventing
tragic situations and finding “win-win” solutions for all persons concerned.
A response to mentally ill crisis events must be immediate. The National Alliance
on Mental Illness/Memphis and the Memphis Police Department agree that an
“immediate response” is preferable to that of specialized mental health workers on
call or a mobile crisis van response. By offering an immediate humane and calm
approach, CIT officers reduce the likelihood of physical confrontations and
enhance better patient care. As such, the CIT program is a beginning for the
necessary adjustment that law enforcement must make from a traditional police
responses to a more humane treatment of individuals with mental illness.

ProgramBenefits
Since the CIT program began in Memphis, the citizens and the criminal justice
system of Memphis have experienced significant benefits of the program. Some of
the benefits of the program are listed below.
 Crisis response is immediate
 Arrests and use of force has decreased
 Underserved consumers are identified by officers and provided with care
 Patient violence and use of restraints in the ER has decreased
 Officers are better trained and educated in verbal de-escalation techniques
 Officer’s injuries during crisis events have declined
 Officer recognition and appreciation by the community has increased
 Less “victimless” crime arrests
 Decrease in liability for health care issues in the jail
 Cost savings

HEALTH EDUCATION :
Health education can takes place during the entire crisis intervention process. It
is emphasized during the evaluation phase. At this time the patent’s anxiety has
decreased, so better use can be made of cognitive abilities. The nurse plans the
intervention to teach the patent how to avoid other similar crisis. Eg : The nurse
helps the patent to identify the feelings thoughts, and behaviours experienced
following the stressful event. The nurse explains that if these feelings, thoughts,
and behavours are again experienced, the patient should immediately become
aware of being stressed and take steps to prevent the anxiety from increasing.
Nurse also involved in identifying people who are at risk for developing crisis & in
teaching coping strategies to avoid the developing of crisis.

Evaluation : To evaluate outcome of crisis intervention , a reassessment is made

to determine if the stated objectives was achieved .have positive behavioral
changes occur ? Has the individual developed more adaptive coping strategies ?
Have they been effective ? Has The individual grown from the experiences by
gaining insight into his or her responses to crisis situation ? Does the individual
believe that he or she could respond with healthy adoption in future stressful
situations to prevent crisis development .
During The evaluation period the nurse & the patient summarize what has
occurred during the intervention . the review what the individual has learnt &
anticipate How he or she will respond in the future . a determination is made
regarding follow up therapy, if needed the nurse provides referral information .

BIBLIOGRAPHY :
1. Perry and Pottar, principles and practice of psychiatric nursing, 1 st edition, Mosbys
publications, page No. 227-242.
2. Fortinash, Holoday Worret; psychiatric nursing care plan, mosbys publication, 3 rd
edition, page No.303.
3. A Glod Carol, contemporary psychiatric mental health nursing, FA Davis company.
Philadelphia. Page No.144, 148.
4. W. Stuart gail, principles and practice of psychiatric nursing 6 th edition, Mosby’s
Publication, page No.228-238.
5. C.Townsend Marry, Psychiatric Mental Health Nursing, F.A.Davis Company, Page
No.123-132.
6. Nursing Journal of India.
7. www.wikipedia.com