A psychiatric emergency is when an individual experiences an acute disturbance of behaviour, thought or mood. If untreated, a psychiatric emergency may lead the individual to harm self or others. It may happen anywhere in any person, whether diagnosed with a mental health problem or not, and requires intervention by another person (not necessarily by mental health professionals).
A mental health crisis is a situation in which an individual’s actions, feelings, and behaviors can lead them to hurt themselves or others. During a mental health crisis, the individual is at risk of becoming unable to self-care and function in a healthy way within the community.
Psychiatric Emergency Features
A person experiencing a psychiatric emergency exhibits the following 4 behavioural elements:
- change and the person’s response towards it
- intolerance towards change and towards other persons involved in the situation
- reaction of significant others
- behavioural change being an instant one
During a psychiatric emergency:
- the person appears to be extremely agitated, possibly tearful, and highly distressed
- the person may make extreme demands to others
- the person may take irrational decisions which seem to be lacking rational judgement
- the person may put self in danger, the consequences of which are not obvious to the person at the time
- the person may lack the capacity to relate to the surrounding reality
- those present during the psychiatric emergency may experience distress and fear, and may act spontaneously in a way that may cause emotional pain or anger following the event
(Ward, 1995)
Psychiatric Emergency Risk Factors
A psychiatric emergency may be triggered by the following psychological responses:
- fear
- rejection
- frustration
- intrusion
- inferiority
- embarassment
- grief
- reality conflict
- psychiatric disturbance
Additionally, a person is more susceptible to experience a psychiatric emergency when:
- experiencing an acute psychological disturbance
- experiencing a stressful situation
- undergoing a detox program
- being admitted to a psychiatric facility
- recovering from anaesthesia
- in an intoxicated state
- medication is being changed
- unexpected worsening of physical condition occurs eg. infection
- witnessing another person’s psychiatric emergency
- being discharged
- receiving follow-up community care
- being cared for in an unfamiliar culture incl. different religious background
Psychiatric Emergency Nursing
Psychiatric emergency nursing may require different types of interventions:
- verbal intervention
- physical intervention
- background management
As a nurse witnessing a PE, aim to:
- provide immediate support to help the person regain control over feelings and actions
- be flexible by treating the person as an individual with different needs
- reduce any possible environmental triggering factors, moving away from the immediate area if required
- provide psychiatric first aid to try to reduce the emotional tension being experienced by the person, steering away from the immediate feelings
- protect the person experiencing a PE and yourself from physical harm
- evaluate the event in both a concurrent and retrospective way to determine the best possible support required by the person
- Ask for help or assistance if needed
PE Nursing Care Cycle
Assessment > Intervention > Resolution > Support
Assessment
The person experiencing a PE should be continuously monitored, assessed and re-evaluated. Focus on what the person wants, whether the person (or anyone else) is in danger, what was the behavioural cause, whether any similar situation occurred to the person before and how it was handled, and what it meant for the person if it happened before.
Intervention
Intervention should be provided as mediation between the person experiencing the PE and what is immediately available. Mediate between danger and safety, acting reasonably and quickly in a concise and unambiguous way. Focus on the person’s immediate thoughts and beliefs about self and what is currently causing the issue. Most importantly, act in a calm and confident way.
Safety
- Inform your colleagues about the situation
- Do not leave the person alone
- Stay at arm’s length from a potentially aggressive or an aggressive person
- Do not let the person stand between you and an exit point
- Approach slowly
- Speak slowly and calmly in a ‘matter of fact’ tone, but show that you care
- Expect that the person may not even reply to your questions
- Be ‘unshockable’
- Do not retaliate, do not manhandle, do not belittle, do not respond to personal abuse, and never strike a person even if provoked
- If grabbed by your clothing, move towards the person rather than away
- If restraining the person is required, do so in a safe manner for all
- Always treat the person experiencing a PE with dignity and respect
Resolution
Resolution occurs when the intervention produces a positive effect and the situation becomes no longer critical. In this stage, provide positive reassurance and affirm that it is safe for the person to feel better and relieved. Avoid patronising – keep acting in a kind and calm way without giving away your authority as a nurse. Make sure you reassess the person’s mental state.
Support
During this stage the nurse should re-evaluate the incident’s effects, and encourage the person to reflect on the incident and any possible triggers that could have led to the PE. The nurse should provide emotional support to the person, as well as seek professional support or support from other colleagues.
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