The Mentally Impaired Patient: How Providers Can Help During A Crisis

As a healthcare professional, you’ve seen it all. You’ve responded to critical medical situations that would leave the average person paralyzed by panic and fear. Heart attacks, drug overdoses and life-threatening injuries – you’ve handled them all! Experience has made you competent, quick on your feet and an expert problem solver. What about the mentally impaired patient – how do you help someone that’s having a psychiatric breakdown or crisis that may or may not involve any sort of physical injury or illness? Read these suggestions on how to execute successful de-escalation techniques that will prevent worsening crisis, and allow your patients to trust that their best interests are your top priority.

When Individuals Are Having a Mental Health Crisis - Think ALGEE!

This simple 5 step action plan will direct you on how to help someone regain a sense of control. You will be able to recognize and respond to a number of mental illnesses – including bipolar disorder, psychosis, schizophrenia, substance abuse disorders, depression, anxiety and other emotional crises.

ALGEE stands for:

Assess for risk of suicide or harm

Listen nonjudgmentally

Give reassurance and information

Encourage professional help

Encourage self-help and other support strategies

The major takeaway from ALGEE is that to be successful with de-escalation and crisis management; you need to do more listening than talking.

While you don’t want your patient to go off on a tangent that leaves him even more distraught, you must allow him to feel heard and validated. Practice ALGEE, and this one powerful de-escalation technique will create trust between you and your patient. Establishing a rapport is half the battle – it’s downhill from there!

Use Therapeutic Words and Actions to Calm Mentally Impaired Patients

Now that we’ve established that your role as a provider should include active listening, what exactly should you say, and what specific words provide the most help to individuals in acute distress?

Remember that others perceive you more by nonverbal messages than the actual words you speak. Be aware of your facial expression. Are your eyes relaying judgment or hostility? What about your body language – are your fists clinched, or are you displaying an aggressive stance with your posture? You’ll get so much further with mentally impaired patients meet them where they’re at.

Let your defenses come down! This doesn’t mean that you have to jeopardize the safety of yourself or those around you. Relating to others means that you are matching your tone of voice to theirs, and expressing genuine compassion through your verbal and nonverbal language.

Therapeutic communication includes eye contact, asking open-ended questions, allowing the patient to speak or vent, nodding occasionally, and paraphrasing back what the patient told you.

Statements that provoke and agitate people are: “Everything will be okay,” “You need my help,” “I know what I’m doing, “You don’t know what’s best for you” and “Trust me.”

De-escalating statements are: “I’m here to listen,” “Please tell me how you’re feeling?” “Please tell me what happened,” “Can I answer any questions for you?” and “What can I do to help you?”

Do you see the difference between words that escalate agitation and language that fosters trust and human connection?  Nontherapeutic statements send the message that you’re superior, “the boss” and know what’s best.

Therapeutic statements explain that although you don’t have all the answers or solutions, you will go the distance to find them.

You’ve been trained to handle yourself during a crisis and understand that your top priority is always the safety of yourself and everyone involved. You also know that demonstrating empathy to a patient in an emergency is essential.  It’s a fine line. You must be able to exude confidence and the ability to control your surroundings, and also communicate genuine concern and respect.

Even the most agitated, out-of-control and manic people have a “reset” button. Do you know how to find it?

If you talk too much, exude a domineering attitude or presume to know how your patient feels, you won’t be able to reach him, and may even create more work for yourself and your team.

You’ve got the brains, guts, and determination to handle the most disastrous medical scenes. Now – practice building your therapeutic communication skills in order to deliver the highest level of care to individuals struggling with mental health disorders.

You never know – Empathy, insight and effective communication may be the only tools you have to use on the worst day of someone’s life.
Your patient may not be the only one hyperventilating. Slow down and breathe. By slowing your respirations, you help someone terrified calm down too. Practice counting backwards from ten to one together. You’ll both relax, and your patient won’t know that the exercise was equally as important for you. By taking a few moments to calm down together, the worried individual will feel comfort from having you there, breathing in sync, and helping them during a distressing time.

Sources & More Information

JEMS, “Know When Uncooperative Patients Can Refuse Care and Transport”

JEMS, “Know When and How Your Patient Can Legally Refuse Care”

JEMS, “Patient Refusal: What to do when medical treatment and transport are rejected”
By Ryan Jackson
Ryan Jackson is the SEM/SEO Manager for Landmark Recovery. Ryan brings expertise in mind altering diseases, substance abuse, and digital marketing. He graduated from Arizona State University where he found his passion for saving lives, helping people, and his love for marketing. Ryan also enjoys playing golf, reading blogs, and anything that has to do with marketing.

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