A Study on Current Situation of Psychological Crisis Intervention in Public Emergencies

Public emergencies exert a significant impact on the mental health of the people,while psychological crisis intervention can efficiently improve the level of the mental health. The existing psychological crisis intervention in China has weakness in organization system,budget input,human resources,social cognition,and other aspects. The psychological crisis intervention work in the future can be performed by actively perfecting the organization management system of psychological crisis intervention,increasing the budget input,strengthening the construction of psychological intervention teams,improving the level of social cognition,and so on.     

The role of pastoral crisis intervention in disasters, terrorism, violence, and other community crises

The term "pastoral crisis intervention" has been defined by Everly (2000) as the functional integration of faith-based resources with traditional crisis intervention assessment and intervention technologies. Pastoral crisis intervention has been differentiated from ministry and the provision of chaplaincy services. This paper provides a public health model for integrating pastoral crisis intervention services within the larger domain of community disaster response, crisis intervention, and emergency mental health.     

The place of crisis intervention in psychiatry

This paper examines the concept of crisis intervention and its relevance to psychiatric practice. Crisis theory originated in relation to healthy subjects disturbed by major life hazards. Its application, however, has been widened in an uncritical manner to include patients with psychiatric disorders. To what extent crisis theory and intervention can be applied is discussed and relevant research on the outcome of their use in a variety of settings reviewed. It is concluded that although crisis theory cannot be transplanted in its entirety into psychiatry, modified versions might prove useful. The role of crisis in inducing behaviour change in a variety of psychiatric settings and the ways in which this might be harnessed are of considerable interest and worthy of careful investigation.     

Critical incident stress management and the assaulted staff action program

Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) is a clinical and administrative approach to address the psychological sequelae in the aftermath of critical incidents. CISM is a comprehensive, multicomponent crisis intervention procedure that spans pre-incident preparedness to acute crisis to post-crisis follow up. The Assaulted Staff Action Program (Flannery, 1998) is a voluntary, system-wide, peer-help, CISM crisis intervention program for employee victims of patient assault. ASAP's crisis intervention procedures and empirical results are used to illustrate the potential power and effectiveness of CISM approaches. The implications are discussed.     

Juvenile offender suicide: prevalence, risk factors, assessment, and crisis intervention protocols

Suicide is the leading cause of death in juvenile detention and correctional facilities. Moreover incarcerated juvenile offenders have an estimated suicide risk four times greater than adolescents in the general population. To address the problem of juvenile offender suicide, this article describes the extent of the problem and protocols for intervening with this high-risk population. Procedures for crisis intervention are recommended, and we delineate and discuss the step-by-step sequential Roberts' 7 stage crisis assessment and crisis intervention model. The article concludes with an examination of the extent to which suicide assessment and prevention protocols are currently being implemented in juvenile justice facilities. The implementation of suicide prevention programs has been shown to decrease risk of suicide in juvenile offenders; however, much work is still needed to encourage facilities to implement comprehensive assessment and prevention programs nationwide.     

Innovative, precise, and descriptive terms for group crisis support services: a United Nations initiative

Terminology borrowed from other disciplines for use in crisis intervention is inadvertently open to misinterpretation and misrepresentation. Misconceptions about terminology are most common when terms are transmitted across social, cultural, national, language, and attitudinal boundaries. Critical Incident Stress Management, which is a subset of crisis intervention, encountered that exact problem with three of its terms: demobilization, defusing, and Critical Incident Stress Debriefing. Several flawed studies based on misinterpretations of the meaning of these terms have appeared in the literature. The studies may have stimulated some practitioners of crisis intervention to incorrectly conclude that those interventions were ineffective. Professionals within the Critical Incident Stress Management Unit of the Department of Safety and Security of the United Nations suggested alternative and augmented terminology to reduce the potential for further misinterpretations of Critical Incident Stress Management procedures.     

Critical Incident Stress Management (CISM): a statistical review of the literature

Crisis intervention has emerged over the last 50 years as a proven method for the provision of urgent psychological support in the wake of a critical incident or traumatic event. The history of crisis intervention is replete with singular, time-limited interventions. As crisis intervention has evolved, more sophisticated multicomponent crisis intervention systems have emerged. As they have appeared in the extant empirically-based literature, their results have proven promising. A previously published paper narratively reviewed the Critical Incident Stress Management (CISM) model of multicomponent crisis intervention. The purpose of this paper was to offer a statistical review of CISM as an integrated multicomponent crisis intervention system. Using the methodology of meta-analysis, a review of eight CISM investigations revealed a Cohen's d of 3.11. A fail-safe number of 792 was similarly obtained.     

Prise en charge de la crise suicidaire

The definition of suicidal crisis extends to include different aspects starting from suicidal thoughts and ending with suicidal attempt. The management of the crisis begins at the moment of its identification and evaluation together with the exploration of the precipitating factors. This first step helps finding out the most adequate form of intervention to end the crisis, taking into consideration the moment of the crisis, the level of emergency and the nature of the crisis. The aim of this intervention is to accompany the crisis state while trying to identify the nature and the reasons of the psychical suffering of the person in order to, if possible, avoid a suicidal attempt, avoid fatal cumsequences of an attempt, avoid a new crisis and finally to help the subject survive after the crisis.     

Suicide by cop: causes, reactions, and practical intervention strategies

Due to a combination of interpersonal manipulativeness, personal identification, and lack of heroic status, most police officers find suicide by cop (SBC) calls to be among the most disturbing shooting incidents. This article describes the dynamics of SBC and some of the factors that may contribute to it. Operational strategies and psychological techniques for de-escalating and resolving a SBC crisis are discussed. Finally, psychological reactions by officers to a SBC and psychotherapeutic strategies for dealing with the aftermath are described. Especially important is the recommendation that officers use intervention "failures" as tools for learning, so that purposeless remorse can be turned into enhanced life-saving skills for the next incident.     

Emergency/Adjunct services and attrition prevention for randomized clinical trials in children: the MTA manual-based solution

Treatment studies in child and adolescent psychiatry are increasingly characterized by long-term, multisite, randomized clinical trials (RCTs). During the course of these RCTs it is common for clinical exigencies to emerge that require rapid, direct intervention. The challenge is to provide clinically appropriate responses that do not contaminate the delivery, distinctness, and interpretation of the treatments under investigation. In multisite studies, the problem is compounded by the need to minimize cross-site differences in the delivery of adjunct treatments. Such minimization requires fully operationalized and manual-based procedures for clinically mandated intervention. The NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (ADHD)--"the MTA"--is a long-term multisite collaborative study in which children with ADHD were randomly assigned to either medication management, behavioral treatment, the combination, or community-comparison assessment and referral. In designing its study, the MTA developed a manual-based set of procedures (the MTA Adjunct Services and Attrition Prevention [ASAP] Manual) for situations not covered by the protocol treatments. The majority of cases requiring adjunct services fell into two major categories: (1) crisis/emergent situations and (2) imminent risk of attrition. This report describes the ASAP guidelines for dealing with cases that required adjunct services that the MTA Steering Committee adopted before initiating the trial. Although the manual-based guidelines are especially applicable to multisite RCTs, many of the procedures in the ASAP Manual can apply to any treatment study in children.     

Crisis management briefings (CMB): large group crisis intervention in response to terrorism, disasters, and violence

A single act of violence or terrorism can adversely affect thousands of people. Such acts will invariably engender a psychological morbidity that will far surpass any physical morbidity. Heretofore, efforts in primary and secondary prevention have focused largely upon the physical consequences of these incidents, rather than their psychological consequences. This paper describes a practical group psychological crisis intervention, the "crisis management briefing" (CMB), that may be used with large groups of individuals in the wake of terrorism, violence, disasters, and other crises. This intervention, which is one component of the Critical Incident Stress Management (CISM) crisis intervention system, is designed to mitigate the effects of these crises and requires anywhere from 45 to 75 minutes to implement. The CBM may be employed with groups ranging from 10 to 300 individuals at one time.     

Caplan, community, and Critical Incident Stress Management

Critical Incident Stress Management (CISM), a comprehensive crisis intervention program, is examined from the perspective of Community Psychology. Because CISM adheres to the 5 Principles of Community Psychology and was designed to be adopted and implemented as a systematic intervention embedded within an organization, it is argued that CISM is best understood and evaluated in context as a prevention program rather than simply a crisis intervention "treatment." Recommendations are made for evaluating CISM as a comprehensive intervention-using an Action Research framework encompassing methodological pluralism and multiple stakeholders' definitions of success.     

Five principles of crisis intervention: reducing the risk of premature crisis intervention

Crisis intervention, as it has evolved over the last five decades, has clearly demonstrated its effectiveness as a tool to reduce human distress. Nevertheless, as with any effort to alter human behavior, there are risks associated with crisis intervention. One such risk is that of premature intervention. Premature intervention may not only waste valuable intervention resources, but may serve to interfere with the natural recovery mechanisms of some victims. By clearly defining the nature of the crisis phenomenon itself, premature intervention may be averted.     

Critical incident stress debriefing (CISD): a meta-analysis

Psychological debriefings represent a genre of group crisis interventions. Critical Incident Stress Debriefing (CISD) represents the oldest standardized variation of this genre. Recent reviews have called into question the effectiveness of CISD. In this study 5 previously published investigations were meta-analyzed revealing a large effect size (Cohen's d = .86) supporting the notion that the CISD model of psychological debriefing is an effective crisis intervention.     

Economic impact of crisis intervention in emergency psychiatry: a naturalistic study

OBJECTIVE: This is a naturalistic study comparing the outcomes of all emergency psychiatric interventions in the Hospital Center of Luxembourg during two periods of six months each, before and after the introduction of a crisis intervention program. The aim of the study was to investigate the clinical and economic impact of crisis intervention on psychiatric emergency admissions. METHODS: All subjects admitted to the emergency psychiatric unit during the two study periods were considered for participation. Data were collected retrospectively and comparisons were made between patients before (September 1, 2001 to February 28, 2002) and after (September 1, 2002 to February 28, 2003) crisis intervention programs were established. RESULTS: A comparison between the two patient groups demonstrated a significant decrease in the rate of voluntary hospitalizations after crisis intervention, and a significant increase in the number of patients with subsequent outpatient consultations. The cost increase due to ambulatory follow-ups was widely compensated for by the cost decrease due to hospitalization avoidance. CONCLUSIONS: These preliminary findings suggest that crisis intervention leads to a shift from hospitalization to outpatient psychotherapeutic management in emergency psychiatric services, which has a significant economic impact.     

Some basic considerations in crisis intervention

In an effort to add greater understanding to the concept of crisis intervention, it is proposed that emotional crises be placed on a continuum ranging from normal developmental crises to psychiatric emergencies. If emotional crises are placed on such a continuum, reasons behind crisis intervention are clarified as are the roles of direct treatment and consultation. Along with such clarification it is suggested that a variety of viewpoints of an emotional crisis should be considered in its assessment. This in turn results in a more pragmatic and comprehensive orientation for a community mental health center to effectively assist people in crisis.     

The Assaulted Staff Action Program (ASAP): ten year empirical support for critical incident stress management (CISM)

Critical Incident Stress Management (CISM) refers to an integrated comprehensive, multicomponent, crisis intervention approach for addressing the psychological aftermath of critical incidents. It includes pre-incident training, acute crisis intervention, and post-incident responses. The Assaulted Staff Action Program (ASAP) is a voluntary, system-wide, peer-help, crisis intervention program for staff victims of patient assaults. ASAP is a CISM approach, and this paper evaluated fourteen empirical studies of ASAP to assess the empirical justification for ASAP and CISM approaches, which demonstrated a 25%-62% reduction in staff assaults.     

"Pastoral crisis intervention": toward a definition

The pastoral community represents a large and often untapped resource in times of crisis. It possesses a unique aggregation of characteristics that makes it uniquely valuable amidst the turmoil of a psychological crisis. In critical incidents such as terrorism, mass disasters, violence, the loss of loved ones, and any events wherein human actions result in injury, destruction, and/or death, the pastoral community may possess especially powerful restorative attributes. Unfortunately, heretofore, there has existed no generally recognized and accepted manner in which the healing factors inherent in pastoral care have been functionally integrated with the well-formulated principles of crisis intervention. This paper represents an initial effort to elucidate how the principles of pastoral care may be functionally integrated with those of crisis intervention. The amalgam shall heretofore be referred to as "pastoral crisis intervention" and is defined herein.