Purpose

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Crisis Intervention is the urgent and acute psychological support sometimes thought of as „emotional fist-aid “ (1). Important features are:

 

  • Immediacy (early intervention)
  • Proximity (frequently close to the place of the critical incident).
  • Expectancy (both, the individual concerned and the person who does crisis intervention expect that the intervention will be directed towards the goal of stabilization and reduction of symptoms; it will not be cure).
  • Simplicity (the intervention methods won’t be complicated and therapy strategies won’t be part of the intervention).
  •  Innovation (adjusting crisis intervention to the specific case).
  •  Pragmatism (not theoretical but practical).
  •  Brevity (the intervention will be short).

 

Crisis intervention may be addressed to:

 

  • Primary victims (those directly traumatized by the event)
  • Secondary victims (emergency service personnel who witnessed or managed the traumatic event)
  • Tertiary victims (family, friends, and those to whom the traumatic event may be indirectly communicated)

 

Crisis intervention is provided to help the individual during and after stressful critical incidents

Crisis intervention aims at:

  1. Reduction of the intensity of an individual’s emotional, mental, physical and behavioural reactions to a crisis.
  2. Stabilization of acute symptoms of traumatic stress.
  3. Mitigation of dysfunction.
  4. Supporting recovery from the trauma, so that individuals may regain the level of performance they had before the crisis.
  5. Giving information on symptoms which may occur later.
  6. Providing psychological education in the sense of informing on adequate and on ineffective ways of coping.
  7. Teaching effective coping skills for future problems.
  8. Decreasing the probability of developing serious long-term problems (e.g. PTSD).
  9. Supporting next of kin, giving them information on how to deal with traumatized loved ones.
  10. Supporting the individual’s self-healing abilities.
  11. Provision of access to further help.
  12. Identification of risk and of protective factors that may foster or slow down the healing of the individual.

 

In helping the affected individuals getting back to the level of performance and to the quality of life they had before the critical incident, the benefit of crisis intervention is not only a humanitarian matter but has also economic advantages. The individuals can stay in their workplaces or can soon return to work[R2] .

 Crisis intervention starts as soon as possible after the critical event and may be extended over several days . In an early state of crisis intervention the help may consist merely of being present and being prepared to listen to the individual concerned (16). In some cases, when the event is longer lasting, e.g. when rescue activities continue over many hours, on-scene support may be indicated. This support usually is a one-on-one activity (see below). Crisis intervention personnel should make sure that the ongoing rescue activities are not disturbed. It is important that through the whole process of crisis intervention always the proper method is applied taking into account the psychological state of the individual concerned.

 

Levels of psychological help

 Depending on the kind of care and the qualification of the provider the care that is rendered to individuals affected by traumatic stress may be categorized in three levels:

 

Level 1

 This level comprises self help and help by colleagues (buddy help). Help may consist of breathing techniques, relaxation techniques (17), and positive self-instruction (18). Moreover superiors may apply the SAFER-technique. For the effectiveness of the help it is advantageous if training in self help and in help by colleagues was provided beforehand. Superiors should be trained as peers (see level 2).

 

Level 2

 Level 2 contains preventive measures which go beyond level 1.These measures are provided by peer support personnel or by crisis intervention teams.

Peers (or peer support personnel) are seamen who know work and life conditions of the affected individuals. They should have specific knowledge of traumatic stress, critical incident stress management, and communication techniques for specific crisis situations. They have been trained in providing care in and after psychological crisis.

Crisis intervention teams consist of a mental health person and peers. They perform most of the methods listed below, depending on the composition of the team.

The term mental health person (or mental health support person) is defined differently in different countries. In this chapter the definition of Mitchell and Everly (1) is used. In their opinion mental health personnel have academic training, diplomas, certifications or licenses. According to these authors ordained chaplains may be mental health persons as well.

 

Level 3

 This level encompasses psychotherapy techniques. They are provided by psychological psychotherapists or psychiatrists (see 17.5).