Crisis intervention is a type of brief psychiatric treatment in which individuals or their families are helped in their efforts to forestall the process of mental decompensation in reaction to severe emotional stress by direct and immediate supportive approaches.

1. DEFINITION OF CRISIS: sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem. Types of crisis:
1. Maturational (internal): see Erik Erikson's eight stages of developmental crises anticipated in the development of the infant, child, adolescent, and adult (see Chapter 5. Health Promotion and Maintenance).
2. Situational (external): occurs at any time (e.g., loss of job, loss of income, death of significant person, illness, hospitalization).
3. Catastrophic (external): can occur at anytime (e.g., natural disasters and terrorist attacks).
2. CONCEPTS AND PRINCIPLES RELATED TO CRISIS INTERVENTION:
1. Crises are turning points where changes in behavior patterns and lifestyles can occur; individuals in crisis are most amenable to altering old and unsuccessful coping mechanisms and are most likely to learn new and more functional behaviors.
2. Social milieu and its structure are contributing factors in both the development of psychiatric symptoms and eventual recovery from them.
3. If crisis is handled effectively, the person's mental stability will be maintained; individual may return to a precrisis state or better.
4. If crisis is not handled effectively, individual may progress to a worse state with exacerbations of earlier conflicts; future crises may not be handled well.
5. There are a number of universal developmental crisis periods (maturational crises) in every individual's life.
6. Each person tries to maintain equilibrium through use of adaptive behaviors.
7. When individuals face a problem they cannot solve, tension, anxiety, narrowed perception, and disorganized functioning occur.
8. Immediate relief of symptoms produced by crisis is more urgent than exploring their cause.
3. CHARACTERISTICS OF CRISIS INTERVENTION:
1. Acute, sudden onset related to a stressful precipitating event of which individual is aware but which immobilizes previous coping abilities.
2. Responsive to brief therapy with focus on immediate problem.
3. Focus shifted from the psyche in the individual to the individual in the environment; deemphasis on intrapsychic aspects.
4. Crisis period is time limited (usually up to 6 weeks).
4. NURSING CARE PLAN/IMPLEMENTATION IN CRISES:
1. General goals:
1. Avoid hospitalization if possible.
2. Return to precrisis level and preserve ability to function.
3. Assist in problem-solving, with here-and-now focus.
2. Assess the crisis:
1. Identify stressful precipitating events: duration, problems created, and degree of significance.
2. Assess suicidal and homicidal risk.
3. Assess amount of disruption in individual's life and effect on significant others.
4. Assess current coping skills, strengths, and general level of functioning.
3. Plan the intervention:
1. Consider past coping mechanisms.
2. Propose alternatives and untried coping methods.
4. Implementation:
1. Help client relate the crisis event to current feelings.
2. Encourage expression of all feelings related to disruption.
3. Explore past coping skills and reinforce adaptive ones.
4. Use all means available in social network to take care of client's immediate needs (e.g., significant others, law enforcement agencies, housing, welfare, employment, medical, and school).
5. Set limits.
6. Health teaching: teach additional problemsolving approaches.
5. EVALUATION/OUTCOME CRITERIA:
1. Client returns to precrisis level of functioning.
2. Client learns new, more effective coping skills.
3. Client can describe realistic plans for future in terms of own perception of progress, support system, and coping mechanisms.