Recognition, Care & Protection

It is important to note that there is no singular technique that will work in all situations all of the time. 

​

DE-ESCALATE HIGH ADRENALINE SITUATIONS

Ensure the safety of the individual

• It is a priority that the individual should be reminded that they are safe and help is here.​​

​

Respect the personal space of the individual while maintaining a safe position

• If an individual is already in a frantic state of mind, bombarding them will only escalate the situation. Make sure to maintain a safe distance between you and them as a preventative measure in case the situation escalates into something violent.​

​

Create a foundation of communication

• Speak to the individuals involved in a calm and clear manner. Remember to keep the tone of voice calm, but also optimistic. Positive communication through body language can also be used as a tool to create a more calm environment for the situation. ​

​

Communicate simply and concisely 

• Adrenaline is pumping, thoughts are racing, voices communicating all while the individual is standing there suffering mentally. Comprehension may not be at its most optimal for the individual so clear and simple language will be the best way to create understanding between all individuals involved. ​

• ​Verbal Communication​

  • ​Vocabulary: words used to communicate either written or spoken​​

  • Clarity: shortest, simplest communication is usually the most effective; long and complex communication allows for opportunity of misunderstanding and lack of comprehension of situation and consequences

  • Timing/relevance: remember to allow the communicator time to speak because they want to feel that the listeners are attentive

  • Pacing: speak at a pace that can be easily followed to optimize comprehension; speaking too quickly may imply that compassion is lacking and may not feel worthy

  • Intonation: the tone in which you communicate with the individual displays emotion so be aware of tone when attempting to calm an the individual

• Nonverbal Communication​

  • Appearance​

  • Posture

  • Facial Expressions

  • Eye Contact

  • Gestures

  • sounds

  • Territoriality

  • Personal Space

  • Silence

​

Identify the wants and needs of the individual

• The goal once the person is in a calmer state of mind and communication is met, it is important to identify what the individual wants or needs in order to get the situation under control. ​

​

Listen closely to what the individual is saying/trying to communicate

• Individuals involved in high adrenaline situations need to be heard in order to come to a safe resolution. ​

Agree or agree to disagree

• In some situations, the individuals involved in a high adrenaline situation suffering from mental health disorders may not comprehend what is happening. Remember logic may not be present during a situation like this and sometimes it may require you to agree to disagree. Some arguments may not be based on logic or facts, but correctness for the sake of the argument is not the primary goal. The priority is to ensure that the individuals involved are safe.​

​

Set and maintain clear limits

• Negative behavior or acts have consequences. The individuals involved need to be told in a factual and nonthreatening manner about the consequences that come from the behaviors or acts they have done. ​

​

Offer realistic options/choices while remaining optimistic

• Incarceration is last resort if crime has not been committed. Mental health care facilities, rehabilitation centers or hospitals may be of help.

​

Provide Optimism

• If an individual feels more comfort, understanding, and openness they may be winning to communicate more information in a helpful manner. Offer a phone call or some water if the situation has de-escalated enough. Maintaining human kindness while working with individuals suffering from debilitating mental illnesses, sometimes so severely they don't even realize themselves, is the ultimate goal. Proper recognition, compassion and protection for these individuals that cannot as easily speak for themselves.​

​

Debrief the individual, the staff and the community

• Once the situation is over, analysis and reflection are vital in order to create preventative methods and better techniques for future situations. Communicate with individuals involved, including staff, to get incite on perspective. This debriefing phase aides in education for the future. ​

​

​

DATA COLLECTION

Psychosocial History

​Cultural Beliefs and Practices

• Identify the client's cultural health care beliefs, practices and values

• Determine cultural factors that can impact the individuals care

​

Spiritual and Religious Beliefs

• Ways individuals find meaning, hope, purpose, and peace.

​

MENTAL STATUS EXAMINATION (MSE)

Level of Consciousness

​Alert: Individual is responsive and able to respond. Eyes are able to open and response is made to a normal tone of voice and speech

​

Lethargic: Although the individual is able to open eyes, they are tired and response time is slower

​

Stuporous: The individual requires vigorous or painful (example: rubbing the sternum) stimuli to display only a minimal response

​

Comatose: The individual is unconscious and does not respond to painful stimuli

​

Physical Appearance

Data collection of personal hygiene, grooming, nutrition status, clothing choice and whether the individual looks older than their state age. Indicators of a positive physical appearance include being well-kept, clean, and dressed appropriately for the given environment. 

​

Behavior

Data collection of voluntary and involuntary body movements and eye contact.

​

Mood: The individual's mood provides information about the emotion the individual is feeling.

​

Affect: The Individual's affect is an objective expression of mood.

​

Cognitive and Intellectual Abilities

• Determine the individuals orientation to people, places, and especially time

• Check the individual's memory

  • Immediate: ability to repeat a series of numbers​

  • Recent: ability to recall recent events or the purpose of the current mental health situation

  • Remote: ability to state a verifiable fact about the individuals past

• Identify the individuals level of knowledge. One way to accomplish this is to ask the individual questions regarding their current illness.

• Identify the individual's rate and volume of speech and quality of language. See how the individuals respond to questions and be sure to pay attention to the word choice being used.

• Determine the individual's judgement through hypothetical questions hoping to receive a logical response.

STANDARDIZED SCREENING TOOLS

Mini-Mental State Examination (MMSE)

Objective collection of data regarding individual's cognitive status

• Orientation to time and place

• Attention span (ability to count backward from 7)

• Recalling of objects

• Language: naming of objects, following of commands, and ability to write

Pain Data Collection Tools

• Visual Analogue Scales

• Wong-Baker FACES Pain Rating Scale

• McGill Pain Questionnaire 

​

LIFESPAN CONSIDERATIONS

Children and Adolescents

​Data collection includes temperament, social and environmental factors, cultural and religious concerns and developmental level.

​

Home Environment: What is the relationship between the child and his/her guardians? What is the relationship between the child and other family members such as grandparent's, step-parent's and siblings?

​

Education/Employment: How is the child's school performance? Do they work? (depending on age)

​

Activities: Is the child social? Does the child participate in extracurricular activities or socialize with peers in any way?

​

Drug and Substance Use: Does the child participate in the use of substances like alcohol, tobacco, or illicit drugs?

​

Sexuality: Is the child sexually active?

​

Suicide/Depression: Are there indications of depression? Is the child suicidal or are there noticeable attempts at self-harm?

Safety: Is the child exposed to abuse, violence, or neglect at home, at school, or in the neighborhood?

​

Older Adults

Data collection includes temperament, social and environmental factors, cultural and religious concerns and developmental level. 

​

• Determine functional ability. Examples of functional abilities include the ability to independently get dressed or do household chores.

• Economic and social status

​

​

THERAPEUTIC STRATEGIES IN THE MENTAL HEALTH SETTING

Counseling

• Use therapeutic communication skills

• Assist with the individuals problem solving

• Crisis intervention

• Develop stress management techniques and skills for the individual

​

Milieu Therapy

• Orient the individual to the correct setting they are currently in

• Identify the rules and boundaries of that setting

• Ensure a safe environment for the individual

• Encourage the individual to participate in cognitive or physical activities if appropriate

Promotion of Self-Care Activities

• Offer help with self-care tasks

• Allow plenty of time for the individual to complete self-care tasks

• Set incentives to promote self-care and hygiene

​

Psychobiological Interventions

• Administer prescribed medication

• Continue to teach the individual and family about the prescribed medications

• Monitor adverse affects and effectiveness of pharmacological therapy

​

ESSENTIAL COMPONENTS 

• Time

• Attending Behaviors or Active Listening

• Caring Attitude

• Honesty

• Trust

• Empathy

• Nonjudgmental Attitude

​

EFFECTIVE COMMUNICATION & TECHNIQUES

Silence: sometimes silence may be the best option to create the best communication foundation for the first responder and the individual in question

​

Active Listening: Active listening differs from passive listening in ways that include more attention, eye contact, facial expressions, and body language

​

Questions

• Open-ended questions: these include questions that require more than a yes or no response or a one word answer. These questons require more thought and more words in response which can be useful

• Closed-ended questions: these types of questions require a direct to the point response-often a yes or no answer

​

CLARIFYING TECHNIQUES

Restating: Restating or repeating words, phrases, or sentences may be beneficial for increased clarification

​

Reflecting: reviewing and analyzing situations could he;p clarify communication by creating a environment where an individual understands the situation in a more rational perspective

​

Paraphrasing: Summing up information and explanations is important for several reasons including expressing information to individuals that may have an attention problem, but it also drives the conversation to come to a more functional outcome

​

​

BARRIERS TO EFFECTIVE COMMUNICATION

• asking irrelevant questions

• offering personal opinions

• giving advice

• giving false reassurance

• minimizing feelings

• changing the topic

• asking "why" questions

• offering judgments

• excessive questioning

• giving approval or disapproval

​

DEFENSE MECHANISMS 

• Altruism

• Sublimation

• Suppression

• Repression

• Regression

• Displacement

• Reaction Formation

• Undoing

• Rationalization

• Dissociation

• Denial

• Compensation

• Identification

• Internationalization

• Conversion

• Splitting

• Projection

• Anxiety

​

​

​

​

​