WHAT IS A MENTAL HEALTH CRISIS?

A crisis in general can be defined as an unstable situation with an uncertain outcome in which an individual’s coping capacity is temporarily overwhelmed. Such crises may be generated by external events, intrinsic processes, or a combination of both.

A mental health crisis is defined as an acute disruption of psychological homeostasis in which one’s usual coping mechanisms fail, with evidence of distress and functional impairment. It is a person’s subjective reaction to a stressful life experience that compromises their ability to cope or function (Ernstmeyer & Christman, 2022).

Types of Crises

Crises can be categorized as maturational, situational, adventitious, or sociocultural. Individuals may simultaneously experience more than one type in a given situation.

MATURATIONAL CRISES

Development is a continuous process from infancy to adulthood. Each stage of development brings with it a new set of challenges and opportunities. Maturational (also known as developmental or normative) crises may occur at any transitional period in the normal process of growth and development.

The transitional periods into successive stages of life require cognitive and behavioral changes, and a crisis can develop at any stage of transition. When a person arrives at a new stage, formerly used coping styles are no longer appropriate, and new coping mechanisms have yet to be developed. For a time, the person is without adequate or effective defenses, which leads to increased anxiety and may manifest as variation in the person’s normal behavior. Life stages and related concerns may include:

Infancy

• Forming secure healthy attachments
• Stranger wariness and separation anxiety
• Emotional regulation

Childhood

• Beginning school
• Establishing peer relationships
• Peer competition

Adolescence

• Puberty
• Relationships involving sexual attraction
• Exploring independence
• Choosing a career

Young Adulthood

• Leaving home
• Continuing one’s education
• Getting started in an occupation
• Marriage
• Managing a home
• Pregnancy
• Childbirth

Middle Adulthood

• Physical changes of aging, menopause
• Maintaining social status and standard of living
• Dealing with changes in adolescent children

Older Adulthood

• Decreased physical abilities and health
• Changes in residence
• Retirement and reduced income
• Death of spouse
• Death of friends
• Facing one’s own death
  (Newton, 2022)

SITUATIONAL CRISES

A situational crisis (also referred to as an accidental or external crisis) results from unanticipated, sudden, and unavoidable events that largely affect a person’s identity and roles, and revolves around grief, usually from a loss of an established situation that threatens a person physically, socially, or psychologically. Such events may include:

• Unexpected job loss
• Change in financial status
• Academic failure
• Divorce
• Mental illness
• Birth of a child with a disability or other healthcare issues
• Diagnosis of chronic or terminal illness
• Serious injury
• Death of a child
• Loss of a spouse
  (Behera, 2021)

ADVENTITIOUS CRISES

Adventitious crises have been called events of disaster. They are rare, unexpected happenings that are not part of everyday life and may result from:

• Natural disasters, such as floods, fires, and earthquakes
• Global pandemics, such as influenza and COVID-19
• National disasters, such as airplane crashes, riots, and wars
• Interpersonal disasters, such as assault and rape
• Acts of terrorism
• Crimes of violence (e.g., rape, assault, murder in workplace or school, bombing in crowded areas, spousal or child abuse)

Because of the severity of the effects of such events, normal coping strategies may not be effective, and support systems may not be available because mental health professionals must respond quickly and to large numbers of people, at times including an entire community.

SOCIOCULTURAL CRISES

Sociocultural crises can take many different forms, but they often involve a fundamental challenge to the values, beliefs, and practices that define a particular culture or society. A sociocultural crisis refers to a situation in which a culture or society experiences significant upheaval or disruption. This can be caused by various factors such as political changes, economic instability, natural disasters, discrimination, or other events that disrupt the way of life for a group of people. A recent example would be the COVID-19 pandemic (Forsyth, 2022).

MENTAL ILLNESS CRISES

Individuals with diagnosed mental illness are at greater risk of experiencing a crisis, but very often a crisis occurs before a mental illness has been diagnosed. Individuals living with mental illness face the same stressors as persons who do not have a mental illness, but these stressors can be especially difficult to deal with for someone living with a mental illness.

Such crises can be difficult to predict because often there are no warning signs. Crises can occur even if the person has been complying with treatment or a crisis prevention plan, using techniques learned from mental health professionals. At times the person may present with behaviors that indicate an impending crisis, but other times a crisis can occur suddenly and without warning. It is possible that the first point of contact may be with law enforcement personnel instead of medical personnel since behavioral disturbances and substance use are frequently part of the difficulties associated with mental illness (NAMI, 2020).

PSYCHIATRIC EMERGENCIES

A psychiatric emergency (also called a behavioral crisis) occurs when a person’s behavior is so out of control that the person becomes a danger to self and others. The situation is so extreme that the person must be treated immediately. Psychiatric emergencies involve crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility. Such emergencies can arise due to mental illness, substance use, or medical conditions that can result in mental changes. The signs of a behavioral emergency include:

• Extreme agitation
• Threats to harm self or others
• Yelling or screaming
• Lashing out, throwing objects
  (PsychGuides, 2023)

Phases of Crisis

The CDC describes four phases of crisis:

• Phase 1: Normal stress and anxiety. Exposure to a precipitating stressor is considered a minor annoyance and inconvenience of everyday life. Anxiety levels or stress response begin to elevate. The person tries using previously successful problem-solving techniques to attempt resolution of the stressor. At this point, the individual is rational and in control of behavior and emotions.
• Phase 2: Rising anxiety level. Problem-solving techniques do not relieve the stressor. Use of past coping strategies are not successful. Anxiety levels increase and the person experiences increased discomfort. Feelings of helplessness, confusion, and disorganized thinking may occur. The person may experience tachycardia and tachypnea. Voice pitch may be high, with a more rapid speech pattern. Nervous habits such as finger or foot tapping may be evident.
• Phase 3: Severe level of stress and anxiety. The person uses all possible internal and external resources available. Problems are explored from different perspectives, and new problem-solving techniques are attempted. The person’s capacity to reason becomes significantly diminished, and behaviors become more disruptive. The person may begin to pace or clench fists, communication may include yelling and swearing, and the person may become argumentative or use threats.
• Phase 4: Crisis. If resolution is not achieved, tension escalates to a critical breaking point. The person may experience unbearable anxiety, increased feelings of panic, and disordered thinking process. Many cognitive functions are impaired, and emotions are labile. Some may experience psychotic thinking. At this point, people may be a danger to themselves or others.
  (CDC, 2020a; Ernstmeyer & Christman, 2022)

Balancing Factors

Individuals respond to a crisis in their own unique ways. There are certain factors that determine the way they respond, referred to as balancing factors. These include:

• Perception of the event. The perception one has of an event determines the reaction to the situation. If the person has a realistic perception and access to adequate resources, restoration of homeostasis will occur, and there will be no crisis. A realistic perception occurs when a person can distinguish the relationship between an event and feelings of stress.
• Availability of situational supports. If the person utilizes support from available persons in the environment and receives assistance in solving the problem, a crisis can be averted. These individuals reflect appraisal of the person’s values. When this is not available, the person is more likely to define the event as more overwhelming, thus increasing vulnerability to crisis.
• Availability of adequate coping skills. Coping skills or mechanisms are those methods usually used by an individual to deal with anxiety or stress in order to reduce tension in difficult situations. People may have positive or negative coping mechanisms, and many people instinctively opt for a maladaptive mechanism. These may include denial, rationalization, repression, regression, dissociation, or avoidance. However, if the person can successfully use positive strategies from the past, a crisis can be averted. The inability to use strategies from previous experiences or unsuccessful attempts to use strategies that were successful in the past can lead to continued disequilibrium, tension, and anxiety (Shastri, 2020).

Crisis Resolution

Crises are acute, time-limited situations usually lasting several days but no longer than four to six weeks, which can be resolved in some way. Possible crisis outcomes include:

• The situation will change and the person will return to a precrisis state.
• The person will develop new coping skills and resources.
• The person will avoid crisis by substance abuse, suicide attempt, or other destructive behaviors.

Crises can become growth opportunities when individuals learn new methods of coping that can be preserved and used when similar stressors occur in the future. It is important to note, however, that some precipitating events can never be undone, such as being raped or having a spouse die, and so the option of returning to a precrisis emotional state may not be possible. Even in situations where the crisis may be resolved, the person’s range of possible experiences and feelings has been altered and denial may play a role in a resolution that does not include growth and development of new coping skills.

Depending on the stage of the crisis, various intervention strategies and resources can be utilized. Crisis resolution goals are to return the individual to a prior level of functioning as quickly as possible and to lessen any negative impact it can have on future mental health, including anxiety and depression as well as trauma or stressor disorders such as posttraumatic stress disorder (PTSD), acute stress disorder or adjustment disorder (Ernstmeyer & Christman, 2022).