The Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the offices and agencies of the Department of Health and Human Services (DHHS), offers a number of free training courses on topics like stress, mental and substance use disorders, and coping strategies.
The SAMHSA CAPCE-accredited 鈥�鈥� course covers how first responders can interact with patients experiencing a mental health or substance abuse crisis. The free course can be taken online for CME credit and is a great refresher on de-escalation techniques and how to best take care of patients in crisis.
The modules opened with statistics about mental health and substance use disorders, and common misconceptions are about patients who suffer from these diseases.
Memorable quotes on de-escalating mental health crises
Here are some memorable quotes from the SAMHSA course, 鈥淐reating Safe Scenes鈥�:
鈥淥nly about 7% of total U.S. healthcare spending has been for mental health.鈥�
鈥淩ecognizing the source of your perceptions can help you de-escalate situations before they become a threat.鈥�
鈥淢ental health and substance use crisis calls, by their nature, are going to involve a longer scene time than trauma or medical calls.鈥�
Top takeaways on scene safety
Here are some takeaways on keeping patients and providers safe on scene:
1. Identify and challenge your pre-conceptions
Although you may not realize it, many of us have been influenced to have a certain view of mental illness and substance abuse disorders. The media especially has influenced the way we see individuals with these problems including enforcing the belief that these individuals are beyond help, lazy or violent. Remember that individuals with mental health conditions or substance abuse problems are much more likely to be victims of violence rather than perpetrate violence.
2. Account for historical trauma
A patient鈥檚 history or past experience can help you better understand your patient and what they鈥檙e going through. For example, a patient who has experienced violence from their country鈥檚 military may distrust those in uniform. Survivors of sexual assault may be apprehensive of male providers. Understanding a patient鈥檚 history and how it plays a role in their health today will enable you to give your patient the help that they need.
3. Consider mental and physical health connections
Mental and physical health are intertwined and often one can manifest as the other. Someone suffering from a UTI may be delirious or a chronic health condition may have lead to drug dependence. Make sure that you rule out any possible physical problems when assessing a patient with altered mental status, and don鈥檛 just assume that their behavior is due to their mental health or possible substance use.
4. Remember the don鈥檛s
- Don鈥檛 raise your voice or attempt to talk over a patient
- Don鈥檛 tell the patient to calm down
- Don鈥檛 get defensive
- Don鈥檛 argue with the patient
- Don鈥檛 be judgmental about the patient鈥檚 actions
5. Explain what鈥檚 happening
Even if a patient isn鈥檛 responding to your attempts at de-escalation, explain everything you鈥檙e doing. It鈥檚 important to not make them feel out of control or that they are trapped. People are more likely to be combative if they feel cornered.
6. Establish relationships with your local resources
Having a relationship with crisis counselors, mental health agencies and others in your area can help provide the best care for your patient. Ride alongs are one good way for them to see how you work and how they can best support you. Communicating with them and knowing what resources are available in your community will benefit your patients.
7. Prioritize scene safety
Don鈥檛 forget that you and your teams鈥� safety should be the No. 1 priority on scene. We all want to provide the best possible care, but remember you can鈥檛 do this unless you feel safe.
Learn more about scene safety
Navigate mental health and substance abuse crises and keep patients and providers safe with these resources:
- What EMS leaders need to know about unconscious bias
- Implementing a training program to prevent EMS assaults
- 11 videos to help providers prevent violence, escalation
- Importance of situational awareness process for emergency responders
- 3 steps to improve EMS situational awareness, spot danger
- This 1 magic phrase will stop patient conflicts
This article was originally posted Sept. 9, 2020. It has been updated.
