Crisis Intervention- Analysis and Application

Introduction

The Community Mental Health Act of 1963 was signed into law by President John F. Kennedy in response to the questionable practices of mental health institutions.   The new law helped people suffering from mental illlness who were institutinalized in hospitals move back into their communities during treatment. It allowed for more effective psychotropic medications and treatments to be utilized and made community based care easily available for individuals suffering with mental illness.  (National Council for Behavioral Health, 2013) According to the National Alliance of Mental Heath or NAMI (2013) approximately 61.5 million Americans experience a mental illness each year.  NAMI continues to report nearly 18.1 percent of American adults live with anxiety disorders, such as PTSD, OCD, or generalized anxiety and phobias.  Post traumatic stress disorder is very common and is the root of most crisis situations, such as substance abuse and suicide.  (James & Gilliland, 2013)  This paper will focus on a case in which crisis intervention is utlized and the client displays signs of PTSD.  The paper will provide a plan of action, interpret the crisis and identify the appropriate theory that identifies the crisis.  Futhermore, the paper will use a model of assessment, intervention, and treatment and will discuss the substance abuse of the client’s family and how it affects her directly.  Lastly, the paper will consider ethical issues that may arise during the course of the crisis intervention with the client and other parties involved.

PTSD

The MayoClinic (2015) has defined Post Traumatic Stress Disorder (PTSD) as a “mental health condition that’s triggered by a terrifying event; either experiencing it or witnessing it.”  Individuals who experience a traumatic event and suffer from PTSD may have difficulty coping for months or even years and the trauma will interfere with basic functioning.  Post-traumatic stress disorder is very disruptive causing the client to relieve the trauma over and over again.  Without proper coping techniques the client will attempt to avoid situations that remind them of the event and force them into nonresponsive or psychotic state when triggered.  The client may also become easily agitated, quick to anger, display extreme states of arousal, or suffer from hallucinations or reoccurring nightmares.  The Diagnostic and Statistical Manual of Mental Disorders provides specific standard criteria that should be used when classifying and diagnosing mental disorders.  (The National Center of PTSD, 2015)  When diagnosing a client the clinician should be aware of specific symptoms and behaviors such as reckless or destructive behavior which is identified in Criteria E.  Clinicians conclude that children are more at risk of suffering PTSD after being exposed to a traumatic experience, such as abuse, or witnessing interpersonal violence.  Our client, Cassandra displays behaviors that are thought to be symptoms of PTSD.  As the clinician discovers more about Cassandra’s past, it is learned that she witnessed her mother be victimized both physically and sexually by her father and grandfather and she may have been a victim of such abuse as well.  Dues to these experiences as a child, Cassandra is highly at risk for Post-Traumatic Stress Disorder.   The clinician must also identify intrusive recollections the client may be experiencing from the traumatic event.  The individual must show signs of experiencing recurrent thoughts, dreams, and flashbacks that are causing the stress.  Cassandra is a high rated candidate for Post-Traumatic Stress Disorder and has been experiencing reoccurring nightmares about her father that are causing adverse reactions such as night sweats and curling up into a ball.  Criterion C involved avoidance of associated trauma, people, and activities.  Cassandra is displaying acts of avoidance as she smiles when talking about her negative experience.  She is disassociated and displays flattened emotional response to the negative experience she shares.  PTSD symptoms must be present for an extended length of time and in this case, Cassandra has received a series of psychiatric treatments that date back to when she was a young girl. She also received psychiatric care when she attempted suicide.  The chronic stress that she suffers stems from the experiences she witnessed as a child and has caused significant duress in her personal life.  Cassandra has lost the ability to cope and continues on an emotional rollercoaster, repeating a series of emotional responses that lead back to its origin.  James & Gilliland (2013) allude that the client must effectively work through the crisis in order to avoid the rollercoaster of emotions that is prevalent in victims.

 

Assessment/Theory/Intervention

Prior to working with Cassandra the crisis worker or clinician will need to collect as much information as possible about the client.  When using the biopsychosocial method of assessment the crisis worker will gather any information that identifies the client, current psychiatric symptoms, treatment history, list of medications, and medical concerns.  It would be beneficial to determine family history including physical, sexual, and substance abuse, personal relationships, and legal or criminal history. The psychoanalytic theory gives us a better sense of Cassandra’s crisis.  This theory suggests the early childhood fixation that Cassandra has on the abuse her mother endured is causing her inert reaction to possible triggers.  A better understanding of the crisis can be achieved by reaching her unconscious troughts and the emotional experiences.  As the clinician work’s through the trauma with Cassandra it is important to maintain client safety and the safety of those around her.  The clinician will intially want to connect with Cassandra and identify any threats to safety for all parties involved.  Although, Cassandra has attempted suicide in the past and has voiced her curiosity with killing someone, there is no immediate threats as she is in the custody of law enforcement.  Once safety has been considered it will be imperative for the clinican to define the problem and establish intial support.  These are the first three steps to Gilliland’s Six Step Method of Crisis Intervention. In the final steps the clinician will work to form coping mechanisms, implement an action plan, and plan a followup session with the client.  The clinician may also utilize the Cognitive method.  This method of crisis intervention focuses on the root problem and the negative thinking that surrounds it. (James & Gilliland, 2013) The clinician will focus on changing the emotions and thoughts that Cassandra houses in response to men and physical touch.  This method is used to rewire Cassandra’s way of thinking and will help return her to a pre-crisis psychological state.  In the current state Cassandra appears to be disconnected and uncertain of the events that have occurred as she continually requests to see her boyfriend and asks if she is going to jail.  She is unaware that she has been in a brutal fight with her boyfriend and that law enforcement believes she murdered him.  She houses a lot of negative emotions due to the overwhelming number of brutal attacks physically and sexually she was forced to witness her mother endure, and expresses her desire to kill someone in her family as payback.  When her boyfriend touched her in a physical manner she correlated the touch with the abuse and responded in a way she had hoped her mother would have when her father and grandfather abused her.  Through the cognitive method the clinician will work through the trauma and rewire Cassandra’s thoughts to understand good and bad touch.  During the assessment it is determined that Cassandra is suffering from Chronic Post Traumatic Stress Disorder with the initial trauma occurring when she was a young girl.  She has links to substance abuse, violence, and factors that can be correlated with problems in personal relationships.

Plan of Action

Together Cassandra and the clinician develop short term goals that are designed to help her cope through the triggered trauma.  Cassandra will remain in the hospital for a 72 hour observation period that will allow her to be observed for any indicated suicidal thoughts and to undergo medical evaluation.  This medical evaluation will help determine any underlying mental illness.  Once discharged she will be released into police custody to face any charges that are due her for the murder of her boyfriend.  Cassandra will be monitored for any repeat suicide ideations.  Cassandra will continue treatments and individual counseling while she is in jail.

 

Alcohol and Chemical Dependency

Cassandra informed the crisis worker that her father was an alcoholic and her brother was addicted to heroin.  James & Gilliland (2013) suggest a correlation between chemical dependency and shared genetic traits.  These genetic traits increase the risk of antisocial personality, ADHD, and forms of conduct disorder.  Studies conducted in mice and rats determine a direct correlation of the genetic influence on substance abuse.  (Browman, Crabbe, & Li, 2000)  In this case, the inherited risk affected Cassandra and her brother differently.  Cassandra developed antisocial personality traits, where as her brother inherited the risk of being addicted to an illegal substance.  The exposure of violence and substance addiction caused the onset of Cassandra’s Post Traumatic Stress Disorder as an adult.  Cassandra is currently experiencing nightmares and is having trouble sleeping at night.   The lack of sleep is a symptom of PTSD in adults and can cause the individual to hallucinate, become irritable, and violent.  As discussed in an earlier portion of this paper, the cognitive method would be effective in processing the trauma she has experienced and help develop coping methods that will enable her to work through any future triggered events.  Assisting Cassandra in anxiety management and Eye Movement Desensitization would be effective treatments for the Post Traumatic Stress Disorder she currently suffers from.

Ethical Dilemmas

Clinicians and case workers must adhere to a strict rule of confidentiality.  They have a legal obligation to protect the client’s privacy and the right of confidentiality through privileged communication.  (James & Gilliland, 2013) The presence of outside parties during the crisis intervention interview can be considered an ethical dilemma in this case.  During the interview, law enforcement officers were present in the room, stood over the patient and listened to every personal detail that was shared.  These officers refused to leave because Cassandra was in their custody.  This is a direct violation of the client’s rights to confidentiality and is a breach of the HIPAA Security Rule.  The Office for Civil Rights enforces the HIPAA Privacy Rule.  The HIPAA rule is enforced to protect the privacy of an individual’s identifying heath record.  (U.S. Department of Health and Human Services, 2015)  Legally, anything that she shares with the crisis worker cannot be used in a court room, and should be considered private.  Prior to initiating the interview the clinician should have requested the officers to leave the room and stand outside the door.  There was no immediate danger to the client or the crisis worker, therefore there was no need for law enforcement officers to monitor Cassandra.

Conclusion

            Post-Traumatic Stress Disorder is prevalent in many individuals suffering from a crisis experience.  As James & Gilliland (2013) have expressed children that witness or experience a traumatic event are more likely to develop a case of PTSD as an adult.  Cassandra suffered symptoms of Chronic PTSD that stemmed from a series of abusive events that she witnessed and experienced as a young girl.  As she grew up she had trouble coping with this crisis and attempted suicide several times.  In a triggered event she attacked her boyfriend and brutally murdered him.  Through methods of intervention the clinician was able to work through the crisis and help Cassandra identify coping mechanisms that enabled her to maintain a pre-crisis psychological state.  With continued treatment and counseling Cassandra will have the ability to overcome the PTSD.  Traumatic events can change how our bodies and minds respond to triggered stressors.  The role of the crisis intervention worker is to aid the mentally ill in working through a crisis and enable them to deal with their struggles so that they can effectively live in society.

 

References:

Community Mental Health Act. (2013, February 25). Retrieved August 11, 2015, from http://www.thenationalcouncil.org/about/national-mental-health-association/overview/community-mental-health-act/

Mental Illness Facts and Numbers. (2013). Retrieved August 11, 2015, from http://www2.nami.org/factsheets/mentalillness_factsheet.pdf

James, R. & Gilliland, K. (2013). Crisis Intervention Strategies (7th ed). Cengage Learning Inc. Obtained from https://online.vitalsource.com/#/books/9781285404714/pages/56707132

http://www.ptsd.va.gov/professional/PTSD-overview/diagnostic_criteria_dsm-5.asp

Post-traumatic stress disorder (PTSD). (2015). Retrieved August 11, 2015, from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540

DSM-5 Diagnostic Criteria for PTSD Released. (2015). Retrieved August 11, 2015, from http://www.ptsd.va.gov/professional/PTSD-overview/diagnostic_criteria_dsm-5.asp

Browman, K., Crabbe, J., & Li, T. (2000). Genetic Strategies in Preclinical Substance Abuse Research. Retrieved August 6, 2015, from http://www.acnp.org/g4/gn401000077/ch.html

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Reliving the 60’s

This post is a lil different.  I would like to share with you a creative perspective on the 1960’s.  I wrote this paper for my “hippie” class.  I absolutely loved this class thanks to my super awesome professor.

 

 

 

My name is Tara Anderson; I am the Chief Archaeologist on this excavation of the Old America.  My team and I are particularly interested in unraveling the hidden stories of the 1960’s.  The 60’s were a time of change and political stances.  We had just come out of WWII and our country leaders were looking for political empowerment, while our people were looking for peace and equality.  Although peace was the focus, our country had to reach some milestones first.  During this time we lost great leaders but won the battle on desegregation and a new outlook among American people.  With this new sense of freedom for all Americans came great expression through art, music, clothing, and food.  It is during this era that America became more defined and this is why my team and I are so interested in knowing the stories of way back when.

Before we head back to the 1960’s, we should start with today.  We are living in the year 2325.  America has changed drastically over the last 300 years and we are forced to live at the mercy of our socialistic government. We are gathering evidence of history that can take us back to a better time, when America was booming.  Perhaps the stories can guide us to make a better tomorrow.  Our excavation has been set up around the memorials in Washington D.C.  During our dig we discovered a space mission spaceship tin metal lunch box buried deep underground near the Lincoln Memorial.  Although the metal box was in weathered condition it had preserved a story that would be told through the artifacts it contained.  As we opened the latch we discovered a letter that was dated August 28, 1963. It was on this day that Martin Luther King, Jr delivered his “I have a dream speech,” in front of nearly 250,000 citizens that had joined the protest for racial equality right there on the steps of the Lincoln Memorial.  The letter was written by Betty Jackson, she was one of the protestors and followed King, Jr to hear his powerful words.  She writes, “What an emotional day!  There were so many people in the crowd; too many to count and when King spoke there was not a bit of chatter in the crowd.  He spoke for all of us today.  It was as though God spoke through him and the angels were rejoicing.  Finally we would be heard and our future would change.  King’s dream is our dream and our future.”  The letter goes on and on to describe the momentum in the air during the March on Washington.  She concludes her letter addressing her dream to walk hand in hand with her white boyfriend without being shamed or arrested for not following the color law.  Martin Luther King, Jr was a powerful speaker.  This speech was one of many that he shared with the public as he led the Civil Rights Movement for people of color.  He was a peaceful man and believed that the American dream could be reached through nonviolent protests.  “He advised the crowds that “we must be sure that our struggle is conducted on the highest level of dignity and discipline” and reminded them not to “drink the poisonous wine of hate,” but to use the “way of nonviolence” when taking “direct action” against oppression.” (Stanford online, 2014)  King was shot and died on April 4, 1968 in Tennessee.  We remember Martin Luther as a man that stood up against the crowd and lived his life serving people.  (Stanford online, 2014)  If it weren’t for his peaceful efforts, diversity in America would not be alive today.

 

After reading the letter we find a peace sign necklace, a ticket for Woodstock 1969, a joint,  and a white banner that reads “Peace, Love, Music-Freedom Fest” in psychedelic colors.  Woodstock took place on a dairy farm in Bethel, NY and was three days of peace and music.  This revolutionary music concert took place during what we call the “hippie era.”  Over 400,000 peace loving hippies came to watch 32 bands perform over the three day music fest and it was rain or shine.  This era was all about expression and inner beauty.  The style was relaxed and yet fashionable. Hippie’s wore peace signs, bright colors, long hair, and bell bottoms.  It was also a time in which women fought against restriction and burned their bra’s to allow their bodies to be free.  It was a time of sex, drugs, and rock and roll.  The lineup included Jimi Hendrix, The Doors, Led Zeppelin, and Chicago to name a few.  Truly an inspirational time.  The only way to survive the experience was to remember that your neighbor was your friend.  (Time, 2012)  All in all there were two fatalities that weekend and two live births within the crowd.

From the tin box we pulled a picture of John Fitzgerald Kennedy.  He was America’s 35th president. JFK was also the youngest president and of Irish decent.  In 1961, during his inaugural speech he promised to get America going again.  His words, “Ask not what your country can do for you–ask what you can do for your country,” still ring true in an honorable president.   (Kennedy, 1961) Kennedy shared Martin Luther’s vision in the cause of equal rights.  He brought forth a sense of American idealism to developing nations.  Kennedy sought peace in America.  In fact his involvement in world affairs was in providing aid, but not boots on the ground.  Our involvement in the Vietnam War was slim during his short term.   He was assassinated in 1963 a few days after approving a coup that would have overthrown Diem a communistic world leader.  (White House online, 2014)

The next piece of history we discovered was a newspaper article during the US involvement in the Vietnam War.  There was much controversy revolving our involvement in the war. Lyndon Johnson pushed for more American militia on the ground.  It was not our war, we went over to Vietnam to help keep the people from falling in to communism.  Unfortunately, we were fighting a war that was not to be won and our men died for nothing.  It wasn’t until 1975 that our troops were called home and the war was over as far as America was concerned.  This was a very sad and tragic time.  When our troops came home the feeling of loss was overwhelming and Americans were very cold to our soldiers.  They were viewed as baby killers and not heroes.

Finally, we look closer at the tin box that protected so many pieces of American history for so many years.  During the 60’s America was trying to beat the clock and send the first man to the moon.  We had already lost the first man in space to the Russians and we surely weren’t going to give up the moon.  It was JFK that put his faith into the NASA program and truly believed we could be the first to explore the moon.  A few years later, in 1969 this dream became a reality and two American men walked the moon for three hours and placed an American Flag on the moon to show we conquered it first.  We dominated the space exploration program and also made a political statement.  It was Neil Armstrong and Buzz Aldrin who walked the moon and collected rock and soil samples to be studied further.  America watched in awe as the walk was aired on national television when Armstrong said those now famous words, “this is one small step for man, one giant leap for mankind.”  This came a few years after JFK’s 1961 speech that led the American people to believe that this event was a realistic goal, not a dream.

Looking back now we can see that 1960’s were a time of great change and evolving for the American people.  With great leaders came great responsibility and a world of wealth for the people.  Dreams became a reality, equality and peace filled the country, and all was good.  This was a great time in history that should always be remembered.  By studying the ways of the past, specifically the 60’s we can make a better tomorrow.  Much like King, Jr and Kennedy two of the greatest leaders we are aspired to know it takes only one voice to move mountains.  We will continue to study our findings of this great era and the passion of America.

 

 

 

 

 

References:

King Jr, M. (1963, January 1). I have a dream. Retrieved September 26, 2014, from http://www.archives.gov/press/exhibits/dream-speech.pdf

 

Martin Luther King, Jr and the Global Freedom Struggle. (n.d.). Retrieved September 27, 2014, from http://mlk-kpp01.stanford.edu/index.php/encyclopedia/encyclopedia/enc_i_have_a_dream_28_august_1963/

 

Assassination of Martin Luther King, Jr. (n.d.). Retrieved September 26, 2014, from http://mlk-kpp01.stanford.edu/index.php/encyclopedia/encyclopedia/enc_kings_assassination_4_april_1968/

 

Lisa Law: Organizing Woodstock. (n.d.). Retrieved September 30, 2014, from http://americanhistory.si.edu/lisalaw/7.htm

 

Vietnam War Records. (n.d.). Retrieved September 30, 2014, from http://www.archives.gov/research/military/vietnam-war/

 

John F. Kennedy. (n.d.). Retrieved September 30, 2014, from http://www.whitehouse.gov/about/presidents/johnfkennedy

 

Dunbar, B. (2008, February 1). The First Person on the Moon. Retrieved September 30, 2014, from http://www.nasa.gov/audience/forstudents/k-4/stories/first-person-on-moon.html