Crisis Counseling

I work for a county mental health program and am a member of the Crisis Services.  This essentially means that my entire job is to help members of the community, whether a client at my agency or not, manage their "crisis".  For some people a crisis may be simply not having the medications that they have been prescribed, to being homeless for the first time, to the more severe cases of wanting to kill themselves or others. 

 

Prior to taking this position I was a drug and alcohol counselor, which surprisingly enough, was a lot more stressful.  There seemed to be more of a constant pressure from the day-to-day job duties that was certainly taking a toll on me, plus working late into the evenings to do group therapy was not helpful.  My job now consists of working from 8:10am to 5pm and every other week I get Mondays off. 

My crisis team consists of a colleague and my supervisor plus the support of some doctoral interns most days of the week.  Due to each of us having specific skills and comfort levels, I tend to go to the hospitals to see clients whereas my colleagues manage the walk in crisis situations.  I love going to the hospitals because I get to be out of the office and working with the physicians and nurses.  It is also pretty amazing that in mental health situations where a person who is at the E.R. with thoughts of suicide that I am called in for the "expert" opinion on how to handle the situation. 



Where I see the majority of the people.

Most of the time I come up with some sort of plan with the client to help them look forward to receiving some help and to practice coping skills to allow them to feel safe.  It is quite seldom that I put someone into a psychiatric hospital, which may seem contrary to my line of work.  In fact, most people that are suicidal do not benefit much from going to a psych unit because those issues are not easily resolved and tend to take long term counseling.  The people I put into the psych unit are generally the ones that are psychotic and may inadvertently be a threat to themselves or others and just need to get on appropriate medications. 

One facet of my job which I find very interesting is being able to put someone on a "hold" which allows me to have them sent to a psych unit for further evaluation and this may occur against their will.  This is something that can be a difficult decision to make because going involuntarily to a psych unit can be pretty traumatic at times and yet if it is essential in a person improving their functioning then it may be for the best.  Once on a hold they can only be held for five judicial days and at that point I need to have made a decision on whether or not the person will be able to be released or if I need to seek a civil commitment.  Civil commitment is a legal process that can mandate people to treatment and sometimes to residential facilities where they may live and receive treatment. 

Psych units have changed a lot from the days of "One Flew Over a Cuckoo's Nest".

My job has many different roles at times and yet it all boils down to one thing...being able to manage intense situations in the moment while maintaining my clinical judgment.  I really enjoy being in pressure situations at times and believe I thrive off of it.  It is almost like an adrenaline rush at times when there is a difficult person creating chaos in the E.R. and it is my job to diagnose them and plan on how to best help them.  I really love what I do and encourage other counselors, who are thrill seekers of sorts, to seek out some crisis experience. 

Images taken from the following websites respectively: http://www.kevinmd.com/blog/2008/12/poor-primary-care-access-drives-up.html, http://www.littlereview.com/goddesslouise/movies/cuckoo.htm,