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What would an optimal crisis response to emotional overwhelm look like?

I’m 58 years old and, to date, I have yet to experience a sustained mental health crisis or period of overwhelm; I feel blessed by my good fortune. Nonetheless, in my 30-plus years of work within the mental health system, I’ve tried to help and support numerous people who were suffering mental anguish and emotional turmoil. Based on what I’ve learnt from these interactions with highly distressed human beings, together with my awareness of the fundamental deficiencies within the traditional psychiatric system, I’ve asked myself: What sort of help would I want if I was to suffer a major mental health crisis?

Courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Below I list 6 key elements of an optimal response to my distress and overwhelm.

1. Friends who I feel able to confide in
As my mood plummets and/or my confusion and psychic pain escalates, I feel able to speak openly about my problems to some family members, friends or work colleagues. My social network, and people in the wider community, already grasp the central idea that so-called mental health problems are merely normal human responses to difficult life circumstances; they no longer buy in to the idea that the primary cause of my crisis is some intrinsic brain aberration. As such, I don’t feel stigmatised by my emotional distress, and my associates experience no fear or reluctance to simply ‘be’ with me at this difficult period in my life.

2. Peer support
I’m immediately offered the opportunity to speak to someone who has had first-hand experience of living through a similar crisis to my own. This befriender has endured comparable emotional pain but has survived and reconnected with life, thereby conveying a hopeful message from the outset that things can and will get better for me. My peer supporter is available – via telephone and/or face-to-face – for as long I need them to be, allowing for the development of a trusting relationship with a familiar person.

3. Local crisis house
If the response from my social network and peer supporter is insufficient to contain my distress, and I feel unsafe and out of control, I’m offered instant access to a 24/7 safe house within my local community. Importantly, this crisis facility is not hospital based and provides a non-medical setting staffed by people displaying the core human qualities of genuineness, empathy, respect and compassion. A significant proportion of the supporters within the house have experienced mental health problems of their own and fully grasp what I am going through.

The crisis house provides a safe space for me to regain my equilibrium. The milieu is calming and not too risk averse; the close relationship with other human beings helps counter any self-destructive urges, so there’s no need for any bureaucratic risk assessments. The ongoing message is that I possess the resources and skills to find the solutions to my problems and others will devote their time and support to allow me to do so. I’m allowed time to recuperate, while always retaining the responsibility for my own actions.

Throughout my time in the crisis house, normalising language is used and I am not labelled or tagged with a ‘diagnosis’.

4. Drugs
If I’m experiencing high levels of agitation and/or sleeplessness, I’m offered the opportunity to consider a short-term drug regime with a knowledgeable prescriber. As part of this process, I’m fully informed that psychotropic drugs do not offer a ‘cure’ – after all, I’m not suffering an ‘illness like any other’ – but will reduce arousal by creating an abnormal state of mind that might be preferable to the one I’m currently enduring.

In addition, the side-effects and dangers of long-term use are shared with me, both verbally and in written form. The decision as to whether to take psychotropic drugs is 100% my own; no pressure is placed on me to do so. Nor is there any suggestion that drugs represent a necessary component to my recovery.

5. Community links
Throughout my mental health crisis, and in the aftermath, I am encouraged and supported to maintain links with my friendship network, work base, and community leisure activities. Every effort is made to sustain me in the valued roles I enjoyed prior to my overwhelm. As I stabilise and gain in strength, I’m offered the opportunity to become a peer supporter for other people experiencing mental health problems.

6. Making sense of my experiences
If my mental health crises are re-occurring, I’m offered a menu of talking therapies as a means of enabling me to make sense of my experiences and to become an active participant in finding a sustainable resolution. The range of approaches on offer includes: person-centred counselling; cognitive behaviour therapy; psychodynamic approaches and systemic methods such as Open Dialogue. I’m provided with a concise overview of what each therapy involves so that I can make an informed choice about which is most likely to suit me.

In addition, I’m given the opportunity to develop a formulation, an individualised map of how my problems developed, what triggered their onset, and the factors that might be maintaining them.

 

 

So that’s my attempt to outline what I would consider an optimal response to a mental health crisis. What elements would you ideally like to see in the reaction to your distress and overwhelm?

 

Photo courtesy of David Castillo Dominici at FreeDigitalPhoto.net

5 thoughts on “What would an optimal crisis response to emotional overwhelm look like?

  1. S. Randolph Kretchmar / Reply 8th November 2016 at 2:52 pm

    I would want VERY clear and objective warnings about any specific behavior of mine that could cause me to be restrained or disabled to protect other people. There should be no condescending pretense that restraint would be “help” or “treatment”. Even were I to be restrained, e.g., from suicide, I’d almost prefer to be told that other people are simply unwilling to deal with the sudden appearance of an unexpected dead body, not that I was making a bad decision or that I am loved and everyone would miss me.

    • Gary Sidley / Reply 9th November 2016 at 10:16 am

      I believe the issue of coercion – if and when it’s justified – is a complex one. Your request for clarity around the criteria seems perfectly reasonable. Although people may occasionally lose the wherewithal to make their own decisions (always temporarily in the realm of mental health problems) there should, in my opinion, be no coercion when someone retains capacity. Although we should all be offered the opportunity for temporary sanctuary and support when feeling self-destructive, the ultimate responsibility must remain with the individual.

  2. Jonathan Gadsby / Reply 8th November 2016 at 4:05 pm

    Once again Gary you have managed to put very clearly some practical ideas based around a lot of thinking. Thank you.

    For me, there would be one more thing. Perhaps this is more because I know myself and I know the likely causes of overwhelming feelings in my life. I think we live at an extremely disturbing moment. Of course, there have been many periods of history in which those living in them have felt this. There have been many periods in which people have felt powerless. However there is something about right now – this incredible combination of political power of being handed over to financial ideologies and what seemed to me to be very accurately described as “post truth” events and societies – that is uniquely confusing and upsetting and pushes us to dissociate. In fact, it seems to me that health IS dissociation in 2016. It is not possible to be mentally healthy and yet be someone who is concerned with social justice and understanding the politics, vested interest, and real causes behind the news. Instead, we limit ourselves, we limit our knowledge of this mess of confusion according to what we personally can take, how much confusion and distress we can live with. That is why I say that health and dissociation are the same thing in 2016. In the past, we have believed that health and information – an informed position – go hand-in-hand. This has been reversed.
    It makes the quest to try to understand the world in a way that could lead to actions of social justice somehow highly isolating and frightening. So few people are willing to spend any time talking together about Syria, suicide bombing, popularism, what Naomi Klein and others call the “industrial military complex”, nuclear threat, climate change, corporate power, et cetera et cetera, most people quickly become full up and reach either literally or metaphorically for their adult colouring books.
    All of this is me trying to say that I do not know who I would need to be with in order to regain wellness, to come back from a period of deeply overwhelmed. Would I need to be with those who are calm – and how could you be calm and also engaged with the world right now – or would I need to be with those who are out-raged, shouting? Who could possibly offer me reassurances right now?
    So, to cut a long story short… What I am saying is that I do not believe I can be mentally healthy in this world. The possibilities and resources you outlined above seem like they are many hundreds of percent better than the status quo. But who will sit with me and acknowledge that the world only offers happiness to the ignorant, shallow and dissociated?

    • Gary Sidley / Reply 10th November 2016 at 3:45 pm

      Wow, Jonathan, what a response. Since I read it yesterday, I’ve been thinking a lot about your assertion that, in our current political climate, health and dissociation are the same thing. Your argument makes a lot of sense. After the initial shock following the disturbing news about Trump I’ve been thinking about its implications less and less – as I’ve reminded myself now, the discomforting thoughts about the world my children (and, in time, grandchildren) will have to negotiate cause me agitation and dread, and I wouldn’t be able to function fully if I remained aware. On a similar note, I watched the David Attenborough wild life programme earlier in the week that included a disturbingly memorable scene where newly hatched turtles had to run the gauntlet of multiple, fast-moving snakes – superb camera work, but like something out of horror movie. If I think too much about the couple of turtles that got ensnared, crushed and swallowed I’m sure I wouldn’t sleep at night.

      The health-dissociation link also reminded me a bit of the idea about ‘depressive realism’ and the related cognitive literature – the suggestion that if we all perceived the world around us in an unbiased way we would all be depressed. Similarly, I recall watching a video many years ago showing Albert Ellis doing Rational Emotive Therapy where, at point within the session, he screams, ‘Do you expect the world to be fair?’ – The implication, of course, being that if we expect a world of fallible human beings to always behave fairly we are irrational and setting ourselves up for a depressive breakdown.

      Would you mind if I copied your comment and posted it on our ‘Drop the Disorder?’ site? I’m sure it will generate an interesting debate. Please let me know if you are OK with this.

      And finally, how did your Cork presentation go down? I bet – in the words of Delboy Trotter – you ‘knocked ‘em bandy!’

  3. Adam / Reply 9th November 2016 at 11:16 am

    Thanks for this thoughtful blog.

    Depending on the severity of my crisis, I would have no objection in principle to being offered refuge and support in a clinical environment. I remain hopeful that hospitals need not *necessarily* be an impediment to compassionate, creative, recovery-orientated support, just as ‘crisis houses’ and similar community-based models provide no guarantee against risk-averse, coercive and medically-modelled practices. Of course I don’t deny that certain types of thinking and practice will be more prevalent in certain types of provision, but my advance directive would apply to whichever environment was found for me – assuming I had temporarily lost the ability to organise this for myself. Why hospital-based crisis environments need to exist in the first place is an important debate, but whilst they do, I would not rule this out for my own support.

    Where I am clear – as a mental health professional who has not yet needed services – is that I would not wish to take a psychiatric medication that I have not explicitly asked for. The default of my support network should therefore be that I am not to be given a psychoactive substance, unless I have given my explicit consent. As I write today, I genuinely believe I would rather be temporarily held, or locked in, to protect mine and/or others’ immediate safety, than receive a chemically-induced physical and cognitive impairment – no matter how desirable these effects are to other people.

    The other insistence would be to be given opportunity to discuss and debate my situation and options, with patient people who have the ability to skilfully challenge aspects of my thinking and behaviour, and realise my successes and potential. I would not want my key professional to be someone who sees my problems through the lens of symptoms and illness, but as a complex reaction to my situation (which may be at various stages of being understood).

    Yes, something like that…

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