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  • Writer's pictureDeric Hollings

An Honest Crisis


 

For the advanced internship portion of my counseling graduate studies I participated in work at an outpatient community treatment center for mental, emotional, behavior, and developmental health (collectively, “mental health”). Upon graduating, I gained employment at that facility.

 

When employed, I worked as a team member for a crisis intervention program. Because mental health terms are often misused in common parlance, it may be useful to briefly define terms.

 

Colloquially, a crisis may be defined as an emotionally significant event or radical change of status in a person’s life. For example, beliefs about one’s family dog running away may result in a radical change that is emotionally significant.

 

According to the National Alliance on Mental Health (NAMI), “A mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community.”

 

Unlike some of my colleagues within the mental health field who I’ve heard propose that a mental health crisis relates to anything a client subjectively perceives as traumatic, I prefer the NAMI versus the colloquial definition. This is because not every disagreeable event constitutes a crisis.

 

Likewise, not all displeasing events result in trauma. According to the American Psychological Association, “Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster.”

 

Therefore, accidentally spilling one’s ice latte isn’t indicative of a traumatic mental health crisis, nor is enduring the dissatisfying experience of unrequited love. I’ll even be as bold as to state that an honest mental health crisis doesn’t result when being misgendered by other people.

 

Although these unfortunate events may contribute to one’s activating event, from the perspective of the ABC model pertaining to Rational Emotive Behavior Therapy (REBT), they aren’t indicative of traumatic mental health crises in and of themselves.

 

Again, I’m aware that many of my peers within the mental health field may disagree. Per their interpretive standard, perceivably any event may represent a traumatic crisis. Helpfully, when providing crisis intervention services, the facility at which I worked maintained the following guidelines:

 

Crisis Intervention services are interventions provided in response to a crisis in order to reduce symptoms of severe and persistent mental illness or serious emotional disturbance and to prevent admission of an individual to a more restrictive environment. Crisis intervention services include:

 

·  Assessment of dangerousness of the individual to self or others

·  The coordination of emergency care

·  Behavior skills training to assist the individual in reducing stress and managing symptoms

·  Problem-solving

·  Reality orientation to help the individual identify and manage their symptoms of mental illness

·  Providing guidance and structure to the individual in adapting to and coping with stressors

 

When working as a military policeman (MP) when in the Marine Corps, I learned crisis intervention techniques. However, the services I provided as a qualified mental health professional afforded me an opportunity to enhance my crisis de-escalation skills.

 

For the layperson, there are many resources available on the Internet which may provide helpful information for those who believe they are experiencing a crisis. As a standard response to clients with whom I work, I invite people to consider the following:

 

·  If you need crisis intervention services, you may contact the 988 Suicide & Crisis Lifeline (9-8-8)

 

·  You may also contact the National Suicide Prevention Lifeline (1-800-273-8255)

 

·  You can also try the National Hopeline Network, Suicide & Crisis Hotline (1-800-442-HOPE [4673])

 

·  If you are experiencing an emergency (imminent risk of danger), please call 9-1-1

 

Recently, I was made aware of an X (formerly Twitter) post (formerly tweet) from slightly over a year ago in which an individual self-disclosed her experience with seeking help during a presumed crisis. She stated:


 

 

Because archive software doesn’t necessarily save images when chronicling historic information, it may be useful to spell out exactly what the post states (punctuation errors deliberately left uncorrected):

 

last month i called 911 on myself for feeling suicidal and the bill with insurance is over $2,000. the 15 min “psych evaluation” alone was $400. oh, and they still sent me home that night. it cost me $2k to not take my life. america’s healthcare system is so fucked lol

 

I appreciate the honesty of this individual and I’m grateful for her fearlessness of action through the posting of her experience. Because I’ve worked on one side of the proverbial crisis table, I think it’s important to understand what a person goes through who sits on the other side.

 

Therefore, it may be helpful to manage the expectations people may have regarding crisis intervention services. Although I don’t profess to be an “expert” in this matter, I do maintain professional experience concerning the topic.

 

911 is reserved for emergencies. Think of my earlier example about the family dog having run away. When I was an MP, the Provost Marshal’s Office for which I work would receive weekly calls about lost pets. Those no-emergent matters aren’t what 911 is intended to resolve.

 

However, an honest crisis occurs when an individual experiences an immediate mental health situation in which suicidal ideation (ideas or thoughts) is present, with which one maintains a plan (e.g., pills), and during which intention is expressed (i.e., I’m going to take all of these pills now).

 

Typically, when emergency responders arrive to the location, the person will be assessed for these three elements (ideation, plan, and intent). If an individual is vague about a suicidal threat, it may be considered in the best interest of the person to temporarily have one’s civil rights revoked by detainment from law enforcement officers (LEOs).

 

Whether or not an individual is transported to an inpatient psychiatric facility on a voluntary versus involuntary basis, a psychiatric evaluation is then performed. This could be a short or lengthy process. According to the individual whose post I’ve cited herein, her assessment apparently took 15 minutes to complete.

 

Hypothetically speaking, if involuntarily detained by LEOs and transported for evaluation, a person may deny intent to complete suicide. If this is the case and the individual cannot be persuaded to remain at the facility, one may then depart the facility on one’s own recognizance.

 

After all, involuntary committal is a serious matter. Depriving someone of the right to move freely may infringe upon constitutional rights. This is why when all three aforementioned elements are expressed, it may be considered in the best interest of the person and the public to commit someone for treatment.

 

Personally, I have moral and ethical views regarding this matter – which may be controversial, though I defer to my professional and legal obligations where a crisis concerning suicide is concerned. Also, as the individual who posted her experienced learned, bills for services rendered may result from contacting crisis personnel.

 

Although I’ve not worked in an inpatient psychiatric facility, I’ve maintained contact with counselors, social workers, psychologists, and psychiatrists who have experience in such a setting. To my understanding, if insurance cannot be billed for services, a person may be liable for payment.

 

The cost of crisis-related services may vary according to facility, location, insurance coverage, and other factors. According to one 2012 source that applied to the period when I performed crisis intervention services, the average cost for inpatient psychiatric treatment was as follows:

 

The average cost to deliver care was highest for Medicare and lowest for the uninsured: schizophrenia treatment, $8,509 for 11.1 days and $5,707 for 7.4 days, respectively; bipolar disorder treatment, $7,593 for 9.4 days and $4,356 for 5.5 days; depression treatment, $6,990 for 8.4 days and $3,616 for 4.4 days; drug use disorder treatment, $4,591 for 5.2 days and $3,422 for 3.7 days; and alcohol use disorder treatment, $5,908 for 6.2 days and $4,147 for 3.8 days.

 

However, one imagines the cost of these services doesn’t typically decrease over a decade later. A more recent 2020 source reports:

 

The average adjusted cost per day of an inpatient hospital stay in state and local government community hospitals in the United States was $2,260 in 2018. For inpatient stays in non-profit hospitals, the average adjusted cost per day was $2,653. For inpatient stays in for-profit hospitals, the average cost per day was $2,093.

 

Regardless of how much the cost of services may fluctuate depending on locale and type of treatment or management of symptoms one receives, the length of stay may also vary according to a host of different issues. In the example of the individual who posted her experience, she apparently was sent home on the same night.

 

For a friend of mine who was admitted to inpatient psychiatric treatment due to conditions applying to Florida’s Baker Act, she stayed in a facility for only a few days. Again, the cost of crisis-related services and length of stay is dependent on a multitude of variables.

 

Generally, upon discharge from an inpatient psychiatric treatment facility, a person may then be referred to intensive outpatient treatment. Regarding this approach to mental health care, one source states:

 

An IOP (intensive outpatient program) is a type of mental healthcare that is considered one step up from traditional outpatient therapy where you see a therapist once or maybe twice a week in their office. An IOP is a program where you will likely be in therapy (both group and individual) somewhere between two to three hours a day, three to five days a week.

 

Following IOP care, clients may seek services with a psychotherapist who works in an outpatient setting, as I do. The cost, frequency, duration, and quality of treatment and management of symptoms may vary depending on each individual and one’s presenting issues.

 

Albeit it a brief description of critical care for psychiatric and psychological matters, the current post is intended to provide an honest description of general approaches to mental health crises. With hopefully improved understanding, the reader can now make a well-informed decision regarding this form of medical care.

 

If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.

 

As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.

 

At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!

 

 

Deric Hollings, LPC, LCSW

 

References:

 

988 Suicide & Crisis Lifeline. (n.d.). 988 Suicide & Crisis Lifeline [Official website]. Retrieved from https://988lifeline.org/

APA. (n.d). Trauma. American Psychological Association. Retrieved from https://www.apa.org/topics/trauma

Blanchfield, T. (2023, November 21). How an intensive outpatient program (IOP) works. Verywell Mind. Retrieved from https://www.verywellmind.com/what-is-an-iop-intensive-outpatient-program-5521766

Hollings, D. (2022, November 18). Big T, little t. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/big-t-little-t

Hollings, D. (2023, June 26). Ctrl+alt+del. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/ctrl-alt-del

Hollings, D. (2022, March 15). Disclaimer. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/disclaimer

Hollings, D. (2023, September 8). Fair use. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/fair-use

Hollings, D. (2023, October 12). Get better. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/get-better

Hollings, D. (n.d.). Hollings Therapy, LLC [Official website]. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/

Hollings, D. (2023, September 19). Life coaching. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/life-coaching

Hollings, D. (2023, October 2). Morals and ethics. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/morals-and-ethics

Hollings, D. (2022, March 24). Rational emotive behavior therapy (REBT). Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rational-emotive-behavior-therapy-rebt

Hollings, D. (2022, November 9). The ABC model. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-abc-model

NAMI. (2018). Navigating a mental health crisis. National Alliance on Mental Health. Retrieved from https://www.nami.org/Support-Education/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis/Navigating-A-Mental-Health-Crisis

National Prevention Toolkit. (n.d.). National Hopeline Network, Suicide & Crisis Hotline 1-800-442-HOPE(4673). Florida State University. Retrieved from https://nationaltoolkit.csw.fsu.edu/resource/national-hopeline-network-suicide-crisis-hotline-1-800-442-hope4673/

National Prevention Toolkit. (n.d.). National Suicide Prevention Lifeline 1-800-273-TALK(8255). Florida State University. Retrieved from https://nationaltoolkit.csw.fsu.edu/resource/national-suicide-prevention-lifeline-1-800-273-talk-8255/

PsychU. (2020, May 4). Average U.S. cost per inpatient day in a hospital was $2,260 in 2018. Otsuka Pharmaceutical Development & Commercialization, Inc. Retrieved from https://psychu.org/average-u-s-cost-per-inpatient-day-in-a-hospital-was-2260-in-2018/

Russett, A. [@AndreaRussett]. (2023, March 28). Last month i called 911 on myself for feeling suicidal and the bill with insurance is over $2,000. the 15 min "psych evaluation" alone was $400. oh, and they still sent me home that night. it cost me $2k to not take my life. america's healthcare system is so fucked lol [Post]. X. Retrieved from https://twitter.com/AndreaRussett/status/1640788419092836352?lang=en

Singh, E. (2024, March 8). The girl is crying because she failed [Image]. Playground. Retrieved from https://playground.com/post/the-girl-is-crying--because-she-failed-cltif6vrl08tzs601c0lblq15

Stensland, M., Watson, P. R., and Grazier, K. L. (2012, July). An examination of costs, charges, and payments for inpatient psychiatric treatment in community hospitals. Psychiatric Services. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22588167/

Texas Health and Human Services. (n.d.). 530.003 How to deal with clients who threaten to harm themselves or others. Texas Department of State Health Services. Retrieved from https://www.dshs.texas.gov/hivstd/policy/policies/530-003

UF Health. (2023, June 14). Baker Act. University of Florida Health. Retrieved from https://ufhealth.org/baker-act

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