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Crisis Management Lecture

Crisis: event that a patients defence mechanisms cannot cope with:

Developmental (life-transition events) Existential (inner conflicts and anxieties related to

purpose/responsibility/independence/freedom/commitment)

o Realisation that one will never make a significant impact (hopeless)

Environmental (natural or man-made disasters) people usually deal with these better thanmental health teams suggest

Medical (new diagnosis) Psychiatric (actual syndromes that affect coping) Situational (loss of job, MVA, rape etc.)

Response to crisis (resilience versus developing PTSD)

1. Factors to do with person2. Events or process occurring

Crisis happens to everyone, what follows depends on the personal/environmental factors:

Physiological grief Acute stress reaction PTSD Adjustment disorder

Personal factors

Biologicalo Genetic make-upo Age, gendero Intellectual disabilityo ABIo Illicit substances

Congenital Environmental

Psychosocialo Socioeconomico Home environmento Peer group, relationshipso Employmentso Pre-morbid functioningo Developmental stages

Defence Mechanisms:

Patterns of thoughts, feelings, behaviours that are involuntary Arise in perception to danger Good defence mechanisms reflect developmental stages1.

Psychotic Defencesa. Delusional projection: to put your problems onto to some thing or someone else

(delusional)

b. Denial of external realityc. Distortion: turning the problem into something else, reshaping external reality to meet

internal needs (eg. my twins were taken away rather than dying)

2. Immature defencesa. Schizoid fantasy (withdrawn, hermit-style: withdraw into fantasy world)b. Hypochondriasis (somatisation. If its difficult to explain a psychological problem so it is

turned into a physical expression of your emotions).

c. Passive-aggression (aggression towards others)d. Acting out (Impulse of action, often to draw a desired response from others)e. Idealisation

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3. Neurotic defencesa. Repression (taking the complete opposite belief because the truth causes anxiety,

homophobia in closet homosexuals)

b. Displacementc. Reaction formationd. Dissociatione. Regression (becoming more child-like)

4. Mature defencesa. Altruism (thinking about others)b. Humour (could be worse etc.)c. Suppression (down-size the problem, deal with the problem in your own comfort zone

in your own time; perhaps putting the problem off to deal with other problems)

d. Anticipation (look ahead and see when a problem may arise, anticipating the problemahead of time)

e. Sublimation (taking out your aggression on another past-time, eg. sport)Coping Skills: adaptive or maladaptive

Stages1. Mounting tension2. Plateau of disorganisation3. Mobilisation of external/internal resources4. Adaption or maladaptation

Crisis counselling

1. Facilitating the expression of emotion2. Facilitating communication3. Facilitating the patients understanding of their problems and responses4. Showing concern and empathy5. Bolstering self-esteem6. Problem-solving

a. Define problem realistically (what/why/who/where of the factors involved)b. Define goals -> generate solution

7. Use of medication: lower the level of arousal / treat distress / sleep disturbanceAngry Patient: Not normally a personality trait (per se), more a manifestation of experiences:

o Paino Previous experiences with health

professionals

o Fear of rejection

o Drug intoxication / withdrawalo Displacement of internal anger

externally

Countertransference: feelings healthcare professionals have towards patients

Run late, fail to treat with respect, fail to provide information, take short-cuts