Publications from ODSW Social Insights: Letters by DSW (Vol 2) | Page 73

Practice Issues
An individual who is in crisis is also in a state of heightened vulnerability.
It is important that those responding to the crisis are well versed in the
individual’s rights, eg. the right to confidentiality, the right to legal counsel,
the right to be free from unwarranted seclusion or restraint, the right to leave
and the right for a minor to receive services without parental notification. It
is good that appropriately trained advocates are available to provide the
needed assistance. Whether true or not, many individuals with serious mental
illnesses have come to regard mental health crisis interventions as episodes
where they feel that their rights are being trampled upon or ignored and
their voice unheard. Meaningfully enacting values of shared responsibility
and recovery requires that the individual have a clear understanding of his
or her rights and access to the services of an advocate. It is also critical that
crisis responders do not give the impression that an individual’s exercise of
rights is a hostile or defiant act.

Services are sensitive to trauma experienced by a
person
Adults, children and older adults with serious mental or emotional problems
often have histories of victimization, abuse and neglect, or significant
traumatic experiences. Their past trauma may be in some ways similar
to the mental health crisis. It is essential that crisis responses evaluate an
individual’s trauma history and the person’s status with respect to recovery
from those experiences.
Similarly, it is critical to understand how the individual’s response within the
current crisis may reflect past traumatic reactions and what interventions
may pose particular risks to that individual based on that history. Because
of the nature of trauma, appropriately evaluating an individual requires
far more sensitivity and expertise than simply asking a series of blunt and
potentially embarrassing questions about abuse using a checklist. It requires
establishing a safe atmosphere for the individual to discuss these issues and
to explore their possible relationship to the crisis event.

Recurring crises signal problems in assessment or
care
Certain individuals seem to experience recurrent crises that may activate
emergency services or land them repeatedly in the A&E department or with
the police. They may also be known as “frequent users” or “high-end users”
of services. In some settings, processing these individuals through repeated
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