Crisis Intervention & Private Practice
By Holly Mathers, BA, MTS
Crisis intervention skills benefit therapists in private practice and their clients. Many therapists do not work with people dealing with more severe mental health issues or suicidal thoughts on a regular basis. People coping with these issues do come to see therapists in private practice but if the therapist does not ask important questions to find out this information and is uncomfortable dealing with these issues, clients will not get the support they need.
Risk Assessment
Therapists need to be willing to discuss their clients’ suicide risk level. There are training programs available for professionals who want to improve their crisis assessment and intervention skills. One training option is the Applied Suicide Intervention Skills Training (ASIST) developed by Living Works (www.livingworks.net).
A risk assessment involves gathering information about the person’s thoughts, plans, and the means they have to follow through on their plan. It is a discussion to see what protective factors and resources they have that would prevent them from hurting or killing themselves. Another important consideration is whether they have had previous suicide attempts, although if they have not had previous attempts it does not mean they are not currently at risk. Trainings like ASIST provide a structured way to gather and organize the information for a risk assessment.
For someone without this training, the essentials are to find out if the person is having suicidal thoughts that involve a specific plan with or without a timeline for taking action. If this is the case, further steps need to be taken in order to ensure the person’s safety.
Accessing Crisis Services
Most urban areas and some rural regions have crisis services that include 24-hour crisis lines. Some also have teams that can respond to crisis situations with professionals like mental health workers, nurses, police, or psychiatrists. Regardless of the specifics of the services, therapists can call a crisis line with a suicidal client. This is a step that is sometimes not taken since therapists are mental health professionals themselves and may not think this is an appropriate use of crisis services.
For therapists that do not have specific training in suicide risk assessment and crisis intervention, this is an important resource to access. Professionals who deal with crisis intervention on an ongoing basis are skilled at assessing the level of risk and providing appropriate interventions. Crisis workers provide a complimentary service to therapy. They have options available to them that go beyond the scope of a typical counselling session.
The Mobile Crisis Team in Waterloo Region, Ontario, is able to speak with professionals, family members and people in crisis over the phone. They also meet with people at their homes or in the community when necessary. They use a recovery, person-centred approach that works from least to most intrusive. If a therapist contacted the team about a client, they would do a risk assessment over the phone. If they determined the client was at risk, they would either create a safety plan over the phone or meet in person to explore options and deescalate the situation.
Least Intrusive Options
The least intrusive options could include getting rid of the means to follow through on the suicide plan, having support people around to ensure safety, or connecting with community supports and resources to begin to address the areas of concern. This might include housing, finances, past trauma, relationship issues, stress, or mental health issues. Another step could involve going to stay at a Crisis Respite house to have support from staff there as an alternative to hospital where this type of service is available.
More Intrusive Options
Going to the hospital to see the psychiatric team would be necessary if there are no other ways to keep the person safe, they need medical attention or medication, or they are experiencing symptoms of psychosis or another mental health issue that requires medical treatment. Even when going to the hospital there are less intrusive ways for that to happen depending on the situation. Someone could go to the hospital with a family member or friend to support them. They could go with a Mobile Crisis Team. If they are at immediate risk, sometimes emergency services need to be dispatched. If a person has a high level of risk and is unwilling to get support, the police may need to be called to apprehend them under the Mental Health Act in Canada to take them to the hospital for a psychiatric assessment.
After-Hours Support
Therapists are not available to their clients 24 hours a day. The 24-hour crisis line is. This can be a support and safety measure available to people between counselling sessions and at times that other professional supports are not available. It is worthwhile for therapist to have crisis services brochures and phone numbers in their offices to provide to clients. Clients can call the line at any time. If a therapist makes a safety plan with his/her client, the crisis line can be included as a part of that plan.
Mental Health Issues
When working in a counselling centre or private practice, many clients are dealing with challenging life issues but not many are coping with more severe mental health issues. Recognizing and responding to mental health issues can be intimidating to professionals who have not had experience in this area however, it is important for therapists to understand these issues and the needs associated with them.
People who hear voices or who experience hallucinations, delusions or paranoia are dealing with stimuli that are only experienced by them. Those experiences can be confusing, distressing, and disorienting. They are often misunderstood by the general public so people exhibiting signs of these symptoms are subjected to the impact of the stigma associated with them.
As a therapist, formulating a response to these behaviours can be challenging. Becoming comfortable asking questions and connecting people to other supports and resources is essential. There are times when clients will need several different supports working together because therapy alone will not address their needs.
Community Resources
Therapists have a responsibility to be aware of the resources in the community they work in. Any one therapist may not be the right fit for every client or every issue. It is important to refer clients to other therapists if necessary. For example, I do not work with children and regularly refer people who contact me about children to a local play therapist who I know does excellent work.
There are also a variety of community organizations, services and resources that can assist people in addition to therapy. There are self-help organizations that provide groups, peer support, information, and resources. Many organizations work in specific areas such as individual illnesses (cancer, multiple sclerosis, diabetes), specific issues (separation/divorce, bereavement, addictions, palliative care, anger management), or with certain populations (children, youth, adults, men, women, seniors).
The Canadian Mental Health Association (CMHA) offers a variety of services and information to people dealing with mental health issues including family members, friends, the public, and professionals. They are a valuable organization to get to know. Staff members at CMHA Mental Health Centres are often aware of many community services and resources.
Other community services are worth exploring for the overall benefit of clients even when they are not directly related to therapy, mental health, or support services. These could include leisure activities in the area, continuing education opportunities, social groups, spiritual/religious communities, fitness classes, and community events. All of these can contribute to the emotional, social, psychological, spiritual, and intellectual well-being of clients.
Collaboration
A danger in the field of social services is for organizations to each do their own separate work and not share information and resources with each other. This can lead to the duplication of services unnecessarily. It can also prevent appropriate referrals from being made when professionals are not aware of what is available.
There are many ways therapists in private practice can collaborate with other organizations through information sharing, co-leading events or workshops, or providing group facilitation on a contract basis. Often social service organizations are interacting with people who may be in need of counselling services and could be referred to a therapist when they know of one who is competent and skilled in their area of focus.
It is sadly amazing how often professionals are doing work that is complementary to other services in the community but other people and organizations are not aware of that work.
Conclusion
Therapists in private practice benefit their clients, themselves and their communities when they educate themselves about crisis intervention and the other resources in their areas. More professionals becoming aware of crisis services and intervention is essential to lower the number of people dying by suicide each year. Being comfortable talking about and addressing more severe mental health issues with clients will help people get connected to essential resources in a more timely manner.
By building relationships and taking a collaborative approach, therapists can further their own practice, provide better person-centred care, and contribute to the bigger picture of social services in their communities.
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