Clinician Perspectives on Mental Health Crisis Intervention: "I Find It a Very Stressful Experience and Also Find It That It's Where I'm at My Peek As a Clinician."

Background: A core competency for mental health providers is the ability to identify and intervene with persons experiencing mental health crises. Several crisis intervention models exist, including the critical incident stress management intervention system (Mitchell, 1983), seven-stage crisis intervention model (Roberts, 1991), and Gilliland’s (1982) six-step model adapted by James (2008). However, little is known about mental health professionals’ processes or strategies for responding to crises. This study explores how front-line mental health workers-- social workers, psychologists, and peer specialists--conceptualize their clients' mental health crises and decide how to best intervene with them.

Methods: Participants (N = 11) serving clients 18 and older were purposefully sampled from a community mental health center, university counseling center, and peer-run center in a mid-sized Midwestern US city. Participants varied with respect to their field experience: less than 5 years (N = 5); 5-10 years (N = 3); and greater than 14 years (N = 3). Single in-depth, semi-structured interviews were conducted face-to-face or over Zoom, lasting approximately 45 minutes. Interviews explored types of crises mental health providers encounter, how providers intervene in crisis, and trainings or policies impacting crisis intervention. Interviews were recorded, transcribed verbatim, and coded using constant comparative, grounded theory method (GTM) to identify themes. The application of GTM was situated within a critical realist framework to orient the researchers to the interplay of structural factors and individual agency shaping the dynamics of crisis intervention.

Results: Five themes were identified: (1) definition of crisis emerged through clinicians’ integration of clinical knowledge, agency policy, and client perspectives to situate crises on a spectrum ranging from mild to severe risk to the client and others. The authors generated a tripartite, recursive model of crisis response, consisting of (2) informal and formal assessment of the client’s biopsychosocial context, including threats to physical and psychological safety and individual and relational strengths; (3) intervention tailored to the client’s unique situation that incorporated diverse approaches (e.g., humanistic, cognitive-behavioral) and skills (e.g., safety planning, grounding techniques, motivational enhancement, problem-solving); and, (4) crisis resolution indicated by securing short-term safety and longer-term, collaborative planning to address the underlying intrapersonal and interpersonal dynamics contributing to crises. (5) Clinicians’ reflective practice was facilitated through quality supervision, collaboration with providers, training, and personal life experiences enabling clinical growth.

Conclusions and Implications: The complexity of mental health crises require providers to balance clinical, client, and agency priorities to assess, intervene in, and resolve clients’ emergent needs. Continuing education for mental health providers surrounding crisis definition, assessment, intervention, and resolution is warranted to safely and effectively assist individuals in crisis. Further, an agency culture promoting collaboration among clients and other mental health providers during crises and de-briefing following a crisis could support clinicians in responding more decisively in future crises. Additionally, agency-specific training for mental health supervisors and continuing education for mental health licensure supervisors regarding crisis response, support of mental health staff and supervisees during and following crisis intervention, and integrated self-care strategies would prove useful in better supporting persons in crisis.