Crisis management

Crisis situations are not uncommon in general practice and people in crisis are usually highly aroused and demanding. Examples include tragic deaths such as children drowning or sudden infant death syndrome (SIDS), unexpected marital break-up and breaking bad news.

Aims of crisis intervention

• Resolve the crisis and restore psychological equilibrium as quickly and constructively as possible.

• Encourage the person in crisis to regain control and take appropriate action.

Principles of management

• Intervene early—actively and directly.

• Establish an empathic alliance.

• Attend to family and social supports.

• Be prepared for the difficult phase of 24-48 hours.

• Do not carry the burden of crisis.

• Aim for brief time-limited intervention (no more than six interviews over six weeks).

• When necessary, be prepared to provide short-term use of psychotropic drugs, e.g. a hypnotic, for two or three nights of good sleep.

Ten rules to help those in distress

The following rules are given to those in crisis (personal explanation followed by a take-home handout):

1. Give expression to your emotions.

You simply must accept your reactions as normal and not be afraid to cry or call out. Do not bottle up feelings.

2. Talk things over with your friends.

Do not overburden them but seek their advice and listen to them. Do not avoid talking about what has happened.

3. Focus on things as they are now—at this moment.

Do not brood on the past and your misfortune. Concentrate on the future in a positive way.

4. Consider your problems one at a time.

Do not allow your mind to race wildly over a wide range of problems. You can cope with one problem at a time.

5. Act firmly and promptly to solve a problem.

Once you have worked out a way to tackle a problem, go for it. Taking positive action is a step in allowing you to get on with life.

6. Occupy yourself and your mind as much as possible.

Any social activity—sports, theatre, cards, discussion groups, club activity—is better than sitting around alone. Many people find benefit from a holiday visit to an understanding friend or relative. Religious people usually find their faith and prayer life a great source of strength at this time.

7. Do not nurse grudges or blame other people.

This is not easy but you must avoid getting hostile. In particular, do not get angry with yourself and your family, especially your spouse.

8. Set aside some time every day for physical relaxation.

Make a point of doing something physical such as going for a walk, swimming or enjoying an easy exercise routine.

9. Stick to your daily routine as much as possible.

At times of crisis a familiar pattern of regular meals and chores can bring a sense of order and security. Avoid taking your problems to bed and thus ensuring sleepless nights. Try to 'switch off' after 8 p.m. Taking sleeping tablets for those few bad nights will help. 10. Consult your family doctor when you need help.

Your doctor will clearly understand your problem because stress and crisis problems are probably the commonest he or she handles. Consult your doctor sooner rather than later. o Remember that there are many community resources to help you cope, e.g. ministers, social workers, community nurses, crisis centres and church organisers. o Take care: do drive carefully and avoid accidents, which are more common at this time.

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