Best Practices for Managing Mental Health Crises in Acute Care Settings

May is Mental Health Awareness Month. Since its inception in 1949, Mental Health Awareness Month has been a cornerstone of addressing the challenges faced by millions of Americans living with mental health conditions. Throughout the month, National Alliance on Mental Illness (NAMI) actively participates in this national movement, dedicated to eradicating stigma, extending support, fostering public education, and advocating for policies that prioritize the well-being of individuals and families affected by mental illness. 

Healthcare workers are typically the first people to interact with individuals in the throes of a mental health crises, with patients often presenting with suicidal ideation or other severe mental health symptoms, posing significant challenges in acute care settings. Mental health crises can include situations such as panic attacks, suicidal ideation, or acute psychosis. Suicidal ideation encompasses a range of thoughts from vague wishes to die to formulated plans to end one’s life.

Read more: Navigating the Complex World of Eating Disorders: Understanding and Treatment 

The role of healthcare workers is pivotal in identifying, assessing, and intervening in such crises to ensure individual safety, provide emotional support, and facilitate appropriate treatment. Here are best practices and evidence-based approaches for healthcare workers handling such crises, focusing on assessment, intervention, and multidisciplinary collaboration.   

• Early Identification and Assessment: Healthcare workers should be trained to recognize signs of a mental health crisis promptly. This includes observing non-verbal cues and changes in behavior. Initial assessments should include risk of harm to oneself or others, which will guide immediate interventions. Comprehensive Assessment includes: 

1. Initial Screening: Implement standardized screening tools to identify risk factors and levels of suicidal ideation among individuals presenting to acute care. 
2. Risk Assessment: Evaluate the immediacy of risk, presence of a plan, and access to means. Prioritize individuals based on the severity and immediacy of their ideation. 

• Safety Measures: Ensuring the physical safety of both the individual and healthcare staff is paramount. This might involve removing potential hazards from the environment and sometimes, when necessary, using restraints as a last resort according to strict ethical and legal guidelines. 
• Environment Safety: Manage the environment by removing objects that could be used for self-harm. Ensure continuous observation for high-risk individuals, using either human resources or electronic monitoring as appropriate. 
• Crisis Response Plan: Develop a personalized safety plan with the individual, which includes recognizing personal triggers, utilizing internal coping strategies, and identifying individuals from personal or professional networks for support. 
• Therapeutic Communication: Utilizing calming techniques and communication skills can de-escalate crises. Speaking in a soft, calm voice, maintaining non-threatening body language, and actively listening are essential strategies. Establishing a rapport, expressing empathy, and validating the individual’s feelings can help stabilize the situation. 
• Empathy and Support: Engage with the individual using a non-judgmental, empathetic approach to build rapport and trust. Validate their feelings and fears without reinforcing suicidal ideation. 
• De-escalation Techniques: Use techniques such as active listening, calm speaking, and supportive dialogues to de-escalate emotional distress. 
• Collaboration and Referral: All healthcare workers should work closely with psychiatrists, psychologists, and social workers. Effective collaboration ensures comprehensive care and appropriate follow-up. Referrals to mental health professionals should be made promptly to ensure continuity of care. 
• Integrated Care: Work closely with psychiatrists, psychologists, social workers, and family members to create a comprehensive, integrated care plan. 
• Referral and Follow-Up: Facilitate timely referrals to mental health services and ensure follow-up after discharge to assess ongoing risk and adherence to outpatient treatment plans. 
• Education and Training: 

1. Continual Learning: All healthcare workers should receive ongoing training in the latest suicide prevention protocols and therapeutic communication techniques. Please see our course catalog for courses on suicide assessment and common mental health diagnoses in acute care. 
2. Simulation-Based Training: Implement regular simulation exercises to prepare staff for various scenarios involving patients at risk for suicide. 

• Suicide Hotline: 988 is now the three-digit dialing code that routes callers to the 988 Suicide & Crisis Lifeline (or 988 Lifeline). On July 16, 2022, the 988 Lifeline transitioned away from the National Suicide Prevention Line reached through a 10-digit number to the three-digit 988 Lifeline. It is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by Vibrant Emotional Health (Vibrant). When people call, text, or chat with the 988 Lifeline, they are connected to trained crisis counselors who are part of the existing 988 Lifeline network, made up of over 200 local crisis centers. These crisis counselors are trained to provide free and confidential emotional support and crisis counseling to people in suicidal crisis or emotional distress and connect them to resources. These services are available 24 hours a day, seven days a week, across the United States. The previous 988 Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis. The 988 Lifeline’s network of over 200 crisis centers has been in operation since 2005 and has been proven to be effective. Trained crisis counselors listen, provide support, and connect callers to resources when appropriate. Callers who follow the “press 1” prompt are connected to the Veterans Crisis Line. A Spanish Language line is available by pressing 2, and more than 240 languages are supported through a Tele-Interpreters service. Callers now also have the option of following a “press 3” prompt to be connected to a crisis counselor specifically trained in supporting LGBTQI+ callers. Numerous studies have shown that callers feel less suicidal, less depressed, less overwhelmed, and more hopeful after speaking with a 988 Lifeline crisis counselor.   
• Documentation: Detailed recording of the crisis intervention is crucial for ongoing treatment planning and legal purposes. Documentation should include the individual’s behavior, the intervention used, and the individual’s response to the interventions. 

Management of mental health crises and suicidal ideation in acute care settings demands vigilance, swift action, and compassionate care from all staff. By adhering to best practices in assessment, safety planning, therapeutic communication, and collaborative care, healthcare workers can significantly mitigate risks associated with suicidal ideation and improve outcomes. So let’s “Take A Moment” to reflect and learn how to help save lives and break the stigma of mental illness to SAVE LIVES!! 

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You cam download the NAMI Mental Health Awareness Month Toolkit from this link to celebrate and spread the word about mental illness. To access the free toolkit, click the link https://www.nami.org/wp-content/uploads/2024/04/NAMI_MHAM_Toolkit_2024.pdf. Substance Abuse and Mental Health Services Administration (SAMHSA) also has a wonderful toolkit free to download https://www.samhsa.gov/mental-health-awareness-month/toolkit.  

CareerSmart® Learning knows the value of a well-supported, well-educated, well-prepared healthcare workforce. We maintain various accreditations by professional licensing and certification organizations and offer CE or contact hours to Nurses, Certified Case Managers, Certified Rehabilitation Counselors, Certified Disability Management Specialists, and Social Workers nationwide.

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