Some Basic Considerations in Crisis Intervention Thomas F. McGee, Ph.D.
ABSTRACT: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.
Although crisis intervention has become widely accepted as a legitimate approach to treatment in mental health, it remains a poorly understood, ill-defined concept. This is true even though an emotional crisis is viewed as a potential source of growth, if opportunely resolved. As a result, considerable anxiety and consternation have been created on the part of mental health professionals over how to adequately identify crises and deal with them more effectively. There is a great deal of uncertainty and confusion over not only why and how to intervene in crises, but what constitutes a crisis and crisis intervention. The following discussion assumes a broad definition of crises, and attempts to provide a framework for a systematization of knowledge in this area. It is hoped that this material will help in understanding why intervening in a crisis is an important, if not imperative mental health approach, which in turn will enhance the effectiveness of crisis intervention. A CONTINUUM OF CRISES Though crises have been with man throughout his recorded history in the form of his reactions to catastrophes or disasters, it is only recently that the mental health professions have begun some systematic study of such phenomena and man's reaction to them: Cobb and Lindeman Dr. McGee is Co-Director, Mental Health Division, Chicago Board of Health, and Assistant Professor of Psychology, Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois. Community Mental Health Journal, Vol. 4 (4), 1968
319
320
Community Mental Health Journal
(I943), and Tyhurst (1957). While psychiatrists, psychologists, and social workers have dealt with emotional crises for years, it is only relatively recently that the concept of crisis intervention has had increased clinical significance attached to it as such. As a partial result, some mental health professionals have rather indignantly asked "Have we not been doing crisis intervention right along?" According to one definition advanced by Rapoport (i965) a crisis is viewed as involving at least three factors: (a) a hazardous, threat-producing event; (b) a threat that arouses both immediate fears and past fears that combine to produce a high degree of emotional vulnerability; (c) the individual's inability to cope adequately with the threat. Such definitions while defining emotional crises, do little to clarify the role, whether new or old, of the mental health professional in relation to crises. In order to more fully answer the questions of what constitutes a crisis and how it can best be approached from a mental health standpoint, it is proposed that crises whether derived from personal, interpersonal or impersonal sources be placed on a continuum. Normal developmental crises such as birth, school entrance and marriage which generally have a low order probability of requiring direct and immediate mental health intervention can be placed at the lower end of such a continuum. Potentially more severe crises such as the loss of a job combined with the death of a family member which pose a high degree of threat and emotional disruption can be placed at the upper end of such a continuum. If crises are viewed on such a continuum, it becomes easier to assess the roles of prevention and consultation as they relate to crisis intervention. In fact, there are certain parallels between such a continuum of crisis intervention and the three phases of prevention when they are also placed on a continuum. In any event, such a continuum provides a broad framework for understanding concepts of crisis and crisis intervention. For example, projects such as those of Cyr and Wattenberg (i957) in maternal and child health can be regarded as preventive efforts directed toward the reduction of potentially disrupting effects arising from normal life crises. Such a framework also clarifies the role of consultation in crisis intervention. Many times individuals in a state of potential or actual crisis do not come directly to a mental health agency. When such individuals come to the attention of the schools, police or derg3r, and consultation is provided to these agencies by a mental health professional, this approach can be construed as a form of crisis intervention. A description of such preventive intervention is provided by Porter (2966). Finally, crisis can be viewed as an emergent, potentially threatening emotional upset which comes to the attention of a mental health professional. This is perhaps the more traditional viewpoint of crisis, and is frequently equated with psychiatric emergencies. In this sense the mental health professional is usually called upon for direct assistance in the form of crisis intervention. It is felt that the more temporally contiguous mental health intervention is to the crisis, the greater the reduction that will
Thomas F. McGee
321
occur in subsequent emotional deterioration and incapacitation. Thus an emotional crisis appears to be a particularly propitious time for intervention. However, such a broadly based framework for understanding what constitutes crisis and crisis intervention serves as only a partial defintion. In order to develop a more comprehensive understanding of this entire area, it is necessary to examine more fully why crisis intervention is important as well as the vantage points from which crises are seen. WHY TO INTERVENE IN A CRISIS Why is crisis intervention an important and necessary mental health approach? As Caplan (296i) has indicated, depending on the type and intensity of the crisis, the individual in crisis may use it as a source of forward movement or growth. On the other hand, the individual may regress to the use of maladaptive devices to cope with the crisis. Crisis intervention is directed at helping the individual avoid this latter type of response, and helping him capitalize on the growth potential inherent in crisis. Thus, well-directed intervention at the appropriate time and place can result not only in a diminution of serious emotional disturbance, but may also serve as a basis for further emotional development. In addition to this general rationale for crisis intervention, the following specific reasons can be advanced: (2) the effects of an emotionally disruptive situation can be reduced: (2) the end results of many untreated crises, i.e., hospitalization and insitutionalization, can often be avoided; (3) the growth aspects of most crises can be promoted, and the debilitating aspects minimized; (4) crisis intervention can frequently save time and effort on the part of mental health professionals; (5) a period of emotional crisis is the only time a large segment of our population will seek mental health assistance and be amenable to it. POTENTIAL VIEWPOINTS OF A CRISIS In more traditional therapeutic work, it has been felt that there are two major viewpoints of an emotional crisis: that of the patient, and that of the therapist. As Peck and Kaplan (i966) have suggested however, individuals rarely experience an emotional crisis in an interpersonal vacuum. Recent thought in the mental health professions leads us to suspect that there are multiple viewpoints from which such a crisis can be examined or experienced. The patient or individual who is the central reactor to the crisis, regardless of its source, is the one who generally provides the most subjective and immediate view of the crisis. He is the one who is experiencing the crisis firsthand. In addition to the value of his viewpoint, we know that the effects of an emotional crisis are rarely limited to or experienced by one individual. The family, relatives, friends or associates of the individual going through an emotional crisis, regardless of its severity, are usually affected
322
Community Mental Health Journal
by the crisis. Unless we explore and evaluate how the crisis is affecting them and their perception of it, we seriously limit our understanding of the crisis. For example, in their work in the South Bronx, Peck, Kaplan, and Rowan (z966) stress the involvement of the total family of the individual in distress when this person first appears for assistance. The community or social or vocational milieu in which a crisis involved individual functions can also play a significant role in assessment and understanding of the crisis. For example, in some communities the birth of an illegitimate child to a teen-aged girl is viewed as a guilt arousing, family disruptive event of catastrophic proportions. In such communities, the child is almost always placed for adoption. In other communities, the same type of crisis has a shock effect of reduced proportions, and the child is rarely placed for adoption. Similarly, with respect to work, it is well known that some employers or occupational situations will tolerate a much wider latitude of deviant behavior on the part of employees than others. An understanding of cultural or social expectations not only helps define whether a crisis exists, but also assists in an assessment of its severity. It also assists in the identification of guidelines for mental health intervention. The therapist or helping agency provides another, hopefully more objective appraisal of the crisis. Traditionally, the therapist or agency has played the largest role in defining a crisis. Research with psychotherapists during the past ~5 years have made us aware of the many differences among them in terms of attitudes, styles, values and approach. With this in mind it is likely mental health professionals can be grouped into at least three categories in terms of their reactions to those in crisis: underreactors, adequate reactors, and over-reactors. In approaching crises, it is helpful to note that what constitutes a crisis and subsequent crisis intervention in the eyes of one mental health professional is not necessarily shared by his colleague. In part, this would appear to account for the reluctance of many mental health professionals to become involved in crisis intervention. Substantial training and experience in dealing with crises appears indicated before a mental health professional can adequately assess and intervene in a crisis. The question as to what types of mental health professionals are best suited to intervene in crises is far from resolved. Other community agencies or organizations may have much to contribute to the assessment of a crisis. The police, ministers, public health nurses, and teachers may have knowledge of factors contributing to the crisis or previous crises. On many occasions such individuals are intimately involved in the early stages of crises and their identification. THE ORIENTATION OF A MENTAL HEALTH CENTER TOWARD MEETING CRISES A discussion of how to intervene in a mental health crisis must be based on an awareness of two primary factors; namely, the limited
Thomas F. McGee
323
number of mental health personnel available to provide services, and the enormous mental health needs of a densely populated community. Recognition of the importance of these factors indicates that as with other mental health services, an orientation toward crisis intervention must strongly emphasize the role of consultation and education. Many mental health crises do not initially come to the attention of a mental health worker; they are first noticed by the police; ministers, public health nurses, and private physicians, to name a few. The range of emotional crises extant will rarely be brought to the attention of mental health workers so constructive action can be undertaken unless we indicate our willingness to pursue them and make our knowledge of and ability to assist in crises more widely available to these individuals. Despite a broadened outlook toward crisis intervention, our overall orientation in this area is related to a fairly traditional model having to do with intake and psychotherapy, among other things, The typical stance of a mental health agency is to wait until the individual in crisis appears for help. Once this occurs, his problem is evaluated, and he usually is offered some form of psychotherapy. As yet, approaches to crisis intervention do not suffciently emphasize the concepts of out-reach and consultation. In order to more adequately attain these goals, at least four considerations are necessary for mental health workers to effectively actualize techniques of crisis intervention.
2. Location. The mental health facility must be located in and involved with a specific community or communities. Though not invariably true, mental health crises usually evolve in a person's home and community. It is likely that the individual will seek help with a crisis more rapidly and before the crisis becomes a seriously disruptive force in his life, if there is a helping resource in his immediate community. It is unrealistic to expect the individual in an emerging crisis to travel a long distance to seek help. It is more likely that such factors will promote a denial of the severity of the crisis. Such are the sociological and geographical forces that contribute to and influence a crisis. 2. Availability. Some portion of the staff must be available or on call to handle crises as they arise. An individual in crisis or a person such as a minister seeking consultation in handling a crisis must be guaranteed an effective contact with a staff member rapidly and during the period of crisis, not two or three weeks hence. A traditionally oriented agency which operates on a 9 to 5, five day a week basis can hardly hope to provide readiness to engage in meaningful comprehensive crisis intervention, in either a direct or consultative fashion. 3. Mobility. The mental health professional who merely waits in a mental health facility for an individual in crisis to appear is not prepared to engage in comprehensive crisis intervention. The staff of a community mental health center must be prepared to physically move out into the community to offer crisis intervention services in either a direct or a consultative manner. If needed, the mental health professional should be willing to accom-
324
Community Mental Health Journal
pany the police or public health nurse to the scene of a crisis, either potential or actual. In many instances, on-the-spot crisis intervention rather than institutional crisis intervention is required. 4. Flexibility-Versatility. Traditional staff patterns of reacting to those in crisis must be scrutinized and probably modified. Specifically, at least one staff person, regardless of professional affiliation, or well-trained volunteer should devote a regular portion of time to handling telephone contacts. The same can be said with respect to walk-in referrals. Such contacts constitute a vital aspect of crisis intervention and are both frustrating and challenging. No mental health worker genuinely interested in crisis intervention can afford to regard such contacts as demeaning and beneath his professional status. It is only through such techniques of adequate and flexible coverage that effective judgment can be made as to whether or not a crisis exists. This, in turn helps define the nature and intensity of the crisis in a rapid manner so that interventive services can be forthcoming quickly. DISCUSSION In the future it is likely that the need for effective, comprehensive crisis intervention services will increase rather than decrease. It is also probable that as mental health services are provided in communities of low socioeconomic levels, programs of crisis intervention will be heavily emphasized. This is particularly true if community mental health efforts are to genuinely and adequately meet the mental health needs of large numbers of people in ways that are both available and comprehensible to them. As a result of increased need for crisis intervention services, increasingly heavy demands will be placed on those involved in providing such services. Since a mastery of techniques associated with crisis intervention requires greater rather than less maturity, sensitivity and competence, more rigorous, systematized training opportunities are required in this area. It is anticipated that such training opportunities will provide a much needed frame of reference and enhance the skills of the fledgling community mental health worker. Of perhaps greater importance, such training opportunities will ameliorate some of the anxiety experienced by established mental health workers who feel ill prepared to plunge into activities like crisis intervention. Training and preparation to meet the needs of crisis intervention should be stressed even though we do not have a solidified body of knowledge in this area as yet. It is apparent that we have much more to learn about the field of crisis intervention. To those who have raised questions about crisis intervention being another catchword for old techniques, the answer can be advanced that until recently we have been engaging in only a fraction of the work possible in crisis intervention. Moreover, we have only begun to capitalize on the many possibilities inherent in crisis intervention. As knowledge about crisis intervention develops, it is likely to be regarded as an exciting treatment modality which can be utilized to a far fuller extent than hitherto.
Thomas F. McGee
325
REFERENCES Caplan, G. Prevention of mental disorders in children. New York: Basic Books, i96I. Cobb, S., & Lindeman, E. Symposium on management of Cocoanut Grove burns at Massachusetts General Hospital: Neuropsychiatric observations. Annals of Surgery, 1943, I17, 814-824. Cyr, Florence E., & Wattenberg, Shirley H. Social work in a preventive program of maternal and child health. Social Work, 1957, 2. Peck, H. B., Kaplan, S. R., & Rowan, M. Prevention, treatment and social action: a strategy of intervention in a disadvantaged urban area. American Journal of Orthopsychiatry,
~966, 36, 57-69. Peck, H. B., & Kaplan, S. Crisis theory and therapeutic change in small groups: some implications for community mental health programs. International Journal of Group Psychotherapy, i966, 16, 135-x49. Porter, R. A. Crisis intervention and social work models. Community Mental Health Journal, I966, 2, 13-a~. Rapoport, Lydia. The state of crisis: some theoretical considerations. In Howard J. Parad (Ed.), Crisis intervention: selected readings. New York: Family Service Assn. of America, I965, Pp. aa-31. Tyhurst, J. S. The role of transition states including disasters in mental illness. Symposium on Preventive and Social Psychiatry, Walter Reed Array Institute of Research, Washington, D. C., ~957.
ABSTRACT: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.
Although crisis intervention has become widely accepted as a legitimate approach to treatment in mental health, it remains a poorly understood, ill-defined concept. This is true even though an emotional crisis is viewed as a potential source of growth, if opportunely resolved. As a result, considerable anxiety and consternation have been created on the part of mental health professionals over how to adequately identify crises and deal with them more effectively. There is a great deal of uncertainty and confusion over not only why and how to intervene in crises, but what constitutes a crisis and crisis intervention. The following discussion assumes a broad definition of crises, and attempts to provide a framework for a systematization of knowledge in this area. It is hoped that this material will help in understanding why intervening in a crisis is an important, if not imperative mental health approach, which in turn will enhance the effectiveness of crisis intervention. A CONTINUUM OF CRISES Though crises have been with man throughout his recorded history in the form of his reactions to catastrophes or disasters, it is only recently that the mental health professions have begun some systematic study of such phenomena and man's reaction to them: Cobb and Lindeman Dr. McGee is Co-Director, Mental Health Division, Chicago Board of Health, and Assistant Professor of Psychology, Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois. Community Mental Health Journal, Vol. 4 (4), 1968
319
320
Community Mental Health Journal
(I943), and Tyhurst (1957). While psychiatrists, psychologists, and social workers have dealt with emotional crises for years, it is only relatively recently that the concept of crisis intervention has had increased clinical significance attached to it as such. As a partial result, some mental health professionals have rather indignantly asked "Have we not been doing crisis intervention right along?" According to one definition advanced by Rapoport (i965) a crisis is viewed as involving at least three factors: (a) a hazardous, threat-producing event; (b) a threat that arouses both immediate fears and past fears that combine to produce a high degree of emotional vulnerability; (c) the individual's inability to cope adequately with the threat. Such definitions while defining emotional crises, do little to clarify the role, whether new or old, of the mental health professional in relation to crises. In order to more fully answer the questions of what constitutes a crisis and how it can best be approached from a mental health standpoint, it is proposed that crises whether derived from personal, interpersonal or impersonal sources be placed on a continuum. Normal developmental crises such as birth, school entrance and marriage which generally have a low order probability of requiring direct and immediate mental health intervention can be placed at the lower end of such a continuum. Potentially more severe crises such as the loss of a job combined with the death of a family member which pose a high degree of threat and emotional disruption can be placed at the upper end of such a continuum. If crises are viewed on such a continuum, it becomes easier to assess the roles of prevention and consultation as they relate to crisis intervention. In fact, there are certain parallels between such a continuum of crisis intervention and the three phases of prevention when they are also placed on a continuum. In any event, such a continuum provides a broad framework for understanding concepts of crisis and crisis intervention. For example, projects such as those of Cyr and Wattenberg (i957) in maternal and child health can be regarded as preventive efforts directed toward the reduction of potentially disrupting effects arising from normal life crises. Such a framework also clarifies the role of consultation in crisis intervention. Many times individuals in a state of potential or actual crisis do not come directly to a mental health agency. When such individuals come to the attention of the schools, police or derg3r, and consultation is provided to these agencies by a mental health professional, this approach can be construed as a form of crisis intervention. A description of such preventive intervention is provided by Porter (2966). Finally, crisis can be viewed as an emergent, potentially threatening emotional upset which comes to the attention of a mental health professional. This is perhaps the more traditional viewpoint of crisis, and is frequently equated with psychiatric emergencies. In this sense the mental health professional is usually called upon for direct assistance in the form of crisis intervention. It is felt that the more temporally contiguous mental health intervention is to the crisis, the greater the reduction that will
Thomas F. McGee
321
occur in subsequent emotional deterioration and incapacitation. Thus an emotional crisis appears to be a particularly propitious time for intervention. However, such a broadly based framework for understanding what constitutes crisis and crisis intervention serves as only a partial defintion. In order to develop a more comprehensive understanding of this entire area, it is necessary to examine more fully why crisis intervention is important as well as the vantage points from which crises are seen. WHY TO INTERVENE IN A CRISIS Why is crisis intervention an important and necessary mental health approach? As Caplan (296i) has indicated, depending on the type and intensity of the crisis, the individual in crisis may use it as a source of forward movement or growth. On the other hand, the individual may regress to the use of maladaptive devices to cope with the crisis. Crisis intervention is directed at helping the individual avoid this latter type of response, and helping him capitalize on the growth potential inherent in crisis. Thus, well-directed intervention at the appropriate time and place can result not only in a diminution of serious emotional disturbance, but may also serve as a basis for further emotional development. In addition to this general rationale for crisis intervention, the following specific reasons can be advanced: (2) the effects of an emotionally disruptive situation can be reduced: (2) the end results of many untreated crises, i.e., hospitalization and insitutionalization, can often be avoided; (3) the growth aspects of most crises can be promoted, and the debilitating aspects minimized; (4) crisis intervention can frequently save time and effort on the part of mental health professionals; (5) a period of emotional crisis is the only time a large segment of our population will seek mental health assistance and be amenable to it. POTENTIAL VIEWPOINTS OF A CRISIS In more traditional therapeutic work, it has been felt that there are two major viewpoints of an emotional crisis: that of the patient, and that of the therapist. As Peck and Kaplan (i966) have suggested however, individuals rarely experience an emotional crisis in an interpersonal vacuum. Recent thought in the mental health professions leads us to suspect that there are multiple viewpoints from which such a crisis can be examined or experienced. The patient or individual who is the central reactor to the crisis, regardless of its source, is the one who generally provides the most subjective and immediate view of the crisis. He is the one who is experiencing the crisis firsthand. In addition to the value of his viewpoint, we know that the effects of an emotional crisis are rarely limited to or experienced by one individual. The family, relatives, friends or associates of the individual going through an emotional crisis, regardless of its severity, are usually affected
322
Community Mental Health Journal
by the crisis. Unless we explore and evaluate how the crisis is affecting them and their perception of it, we seriously limit our understanding of the crisis. For example, in their work in the South Bronx, Peck, Kaplan, and Rowan (z966) stress the involvement of the total family of the individual in distress when this person first appears for assistance. The community or social or vocational milieu in which a crisis involved individual functions can also play a significant role in assessment and understanding of the crisis. For example, in some communities the birth of an illegitimate child to a teen-aged girl is viewed as a guilt arousing, family disruptive event of catastrophic proportions. In such communities, the child is almost always placed for adoption. In other communities, the same type of crisis has a shock effect of reduced proportions, and the child is rarely placed for adoption. Similarly, with respect to work, it is well known that some employers or occupational situations will tolerate a much wider latitude of deviant behavior on the part of employees than others. An understanding of cultural or social expectations not only helps define whether a crisis exists, but also assists in an assessment of its severity. It also assists in the identification of guidelines for mental health intervention. The therapist or helping agency provides another, hopefully more objective appraisal of the crisis. Traditionally, the therapist or agency has played the largest role in defining a crisis. Research with psychotherapists during the past ~5 years have made us aware of the many differences among them in terms of attitudes, styles, values and approach. With this in mind it is likely mental health professionals can be grouped into at least three categories in terms of their reactions to those in crisis: underreactors, adequate reactors, and over-reactors. In approaching crises, it is helpful to note that what constitutes a crisis and subsequent crisis intervention in the eyes of one mental health professional is not necessarily shared by his colleague. In part, this would appear to account for the reluctance of many mental health professionals to become involved in crisis intervention. Substantial training and experience in dealing with crises appears indicated before a mental health professional can adequately assess and intervene in a crisis. The question as to what types of mental health professionals are best suited to intervene in crises is far from resolved. Other community agencies or organizations may have much to contribute to the assessment of a crisis. The police, ministers, public health nurses, and teachers may have knowledge of factors contributing to the crisis or previous crises. On many occasions such individuals are intimately involved in the early stages of crises and their identification. THE ORIENTATION OF A MENTAL HEALTH CENTER TOWARD MEETING CRISES A discussion of how to intervene in a mental health crisis must be based on an awareness of two primary factors; namely, the limited
Thomas F. McGee
323
number of mental health personnel available to provide services, and the enormous mental health needs of a densely populated community. Recognition of the importance of these factors indicates that as with other mental health services, an orientation toward crisis intervention must strongly emphasize the role of consultation and education. Many mental health crises do not initially come to the attention of a mental health worker; they are first noticed by the police; ministers, public health nurses, and private physicians, to name a few. The range of emotional crises extant will rarely be brought to the attention of mental health workers so constructive action can be undertaken unless we indicate our willingness to pursue them and make our knowledge of and ability to assist in crises more widely available to these individuals. Despite a broadened outlook toward crisis intervention, our overall orientation in this area is related to a fairly traditional model having to do with intake and psychotherapy, among other things, The typical stance of a mental health agency is to wait until the individual in crisis appears for help. Once this occurs, his problem is evaluated, and he usually is offered some form of psychotherapy. As yet, approaches to crisis intervention do not suffciently emphasize the concepts of out-reach and consultation. In order to more adequately attain these goals, at least four considerations are necessary for mental health workers to effectively actualize techniques of crisis intervention.
2. Location. The mental health facility must be located in and involved with a specific community or communities. Though not invariably true, mental health crises usually evolve in a person's home and community. It is likely that the individual will seek help with a crisis more rapidly and before the crisis becomes a seriously disruptive force in his life, if there is a helping resource in his immediate community. It is unrealistic to expect the individual in an emerging crisis to travel a long distance to seek help. It is more likely that such factors will promote a denial of the severity of the crisis. Such are the sociological and geographical forces that contribute to and influence a crisis. 2. Availability. Some portion of the staff must be available or on call to handle crises as they arise. An individual in crisis or a person such as a minister seeking consultation in handling a crisis must be guaranteed an effective contact with a staff member rapidly and during the period of crisis, not two or three weeks hence. A traditionally oriented agency which operates on a 9 to 5, five day a week basis can hardly hope to provide readiness to engage in meaningful comprehensive crisis intervention, in either a direct or consultative fashion. 3. Mobility. The mental health professional who merely waits in a mental health facility for an individual in crisis to appear is not prepared to engage in comprehensive crisis intervention. The staff of a community mental health center must be prepared to physically move out into the community to offer crisis intervention services in either a direct or a consultative manner. If needed, the mental health professional should be willing to accom-
324
Community Mental Health Journal
pany the police or public health nurse to the scene of a crisis, either potential or actual. In many instances, on-the-spot crisis intervention rather than institutional crisis intervention is required. 4. Flexibility-Versatility. Traditional staff patterns of reacting to those in crisis must be scrutinized and probably modified. Specifically, at least one staff person, regardless of professional affiliation, or well-trained volunteer should devote a regular portion of time to handling telephone contacts. The same can be said with respect to walk-in referrals. Such contacts constitute a vital aspect of crisis intervention and are both frustrating and challenging. No mental health worker genuinely interested in crisis intervention can afford to regard such contacts as demeaning and beneath his professional status. It is only through such techniques of adequate and flexible coverage that effective judgment can be made as to whether or not a crisis exists. This, in turn helps define the nature and intensity of the crisis in a rapid manner so that interventive services can be forthcoming quickly. DISCUSSION In the future it is likely that the need for effective, comprehensive crisis intervention services will increase rather than decrease. It is also probable that as mental health services are provided in communities of low socioeconomic levels, programs of crisis intervention will be heavily emphasized. This is particularly true if community mental health efforts are to genuinely and adequately meet the mental health needs of large numbers of people in ways that are both available and comprehensible to them. As a result of increased need for crisis intervention services, increasingly heavy demands will be placed on those involved in providing such services. Since a mastery of techniques associated with crisis intervention requires greater rather than less maturity, sensitivity and competence, more rigorous, systematized training opportunities are required in this area. It is anticipated that such training opportunities will provide a much needed frame of reference and enhance the skills of the fledgling community mental health worker. Of perhaps greater importance, such training opportunities will ameliorate some of the anxiety experienced by established mental health workers who feel ill prepared to plunge into activities like crisis intervention. Training and preparation to meet the needs of crisis intervention should be stressed even though we do not have a solidified body of knowledge in this area as yet. It is apparent that we have much more to learn about the field of crisis intervention. To those who have raised questions about crisis intervention being another catchword for old techniques, the answer can be advanced that until recently we have been engaging in only a fraction of the work possible in crisis intervention. Moreover, we have only begun to capitalize on the many possibilities inherent in crisis intervention. As knowledge about crisis intervention develops, it is likely to be regarded as an exciting treatment modality which can be utilized to a far fuller extent than hitherto.
Thomas F. McGee
325
REFERENCES Caplan, G. Prevention of mental disorders in children. New York: Basic Books, i96I. Cobb, S., & Lindeman, E. Symposium on management of Cocoanut Grove burns at Massachusetts General Hospital: Neuropsychiatric observations. Annals of Surgery, 1943, I17, 814-824. Cyr, Florence E., & Wattenberg, Shirley H. Social work in a preventive program of maternal and child health. Social Work, 1957, 2. Peck, H. B., Kaplan, S. R., & Rowan, M. Prevention, treatment and social action: a strategy of intervention in a disadvantaged urban area. American Journal of Orthopsychiatry,
~966, 36, 57-69. Peck, H. B., & Kaplan, S. Crisis theory and therapeutic change in small groups: some implications for community mental health programs. International Journal of Group Psychotherapy, i966, 16, 135-x49. Porter, R. A. Crisis intervention and social work models. Community Mental Health Journal, I966, 2, 13-a~. Rapoport, Lydia. The state of crisis: some theoretical considerations. In Howard J. Parad (Ed.), Crisis intervention: selected readings. New York: Family Service Assn. of America, I965, Pp. aa-31. Tyhurst, J. S. The role of transition states including disasters in mental illness. Symposium on Preventive and Social Psychiatry, Walter Reed Array Institute of Research, Washington, D. C., ~957.
