Crisis
Compulsory treatment
Compulsory treatment during crisis is sometimes necessary in recovery-oriented mental health services.
For someone who is at risk of harming themselves or others, it is better for services to intervene.
A focus on personal recovery is not a charter to stand back and let tragedies happen because the person didn’t ask for or want help. So compulsion during crisis is acceptable, if other options have been exhausted.
A recovery-oriented approach to crisis aims to:
- prevent unnecessary crises
- to minimise the loss of personal
- responsibility
- during crisis
- to support identity in and beyond the crisis
Preventing unnecessary crises
The best way of reducing the likelihood of a crisis is through the development of self-management skills. These lead to agency, empowerment, and the resilience to cope with set-backs.
An important type of self-management skill is the ability to recognise and respond to the symptoms of mental illness.
The challenge in relation to recovery is to undertake early warning signs work in a way which enhances the person’s ability to self-right, rather than creating anxiety about, and over-vigilance for, relapse.
Skills are needed to communicate two messages.
- Not all of life’s bumps are indicators of potential relapse. At least as much effort needs to go into supporting the development of the skills to engage in life and an attitude of being able to deal with adversity.
- Relapse is normal. People struggling to break free from previous behaviour or emotional patterns experience set-backs.
It may be helpful to communicate that most abstinent smokers have made 12-14 previous quit attempts, or that on average millionaires have experienced bankruptcy or near bankruptcy 3.2 times. Positive risk-taking and the associated set-backs are necessary in life – they are a sign of health, not illness.
Minimising loss of personal responsibility during crisis
A recovery-oriented service aims to make as few decisions for the person as possible. This is done by keeping the process of decision-making as close to the person as possible.
Ideally, people make their own decisions. Where they have temporarily lost this ability, their previously elicited views are used, or proxy decision-makers make decisions on their behalf.
Only where these avenues are not available should workers make decisions in the person’s best interests. A key approach to reducing loss of autonomy is therefore the use of Advance statements.
They take many forms, and their legal standing varies by country, but used appropriately they give the information staff need to do their job – which is keeping the person and their values centre-stage during crisis.
Supporting identity in and through crisis
Relationships are of paramount importance during crisis. The traditional service response to a person presenting in crisis has been hospitalisation, and the importance of developing partnership relationships in recovery-oriented in-patient services is becoming clear.
New types of alternative short-term residential services for people in crisis are also becoming available, such as Rethink’s Rotherham Crisis Accommodation (Cedar House) in Rotherham.
