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Don’t do these 5 things while de-escalating mental health/substance abuse crises

Creating a safe scene begins with understanding how your patient’s mental and physical health connect, and in avoiding these pitfalls


“Mental health and substance use crisis calls, by their nature, are going to involve a longer scene time than trauma or medical calls.”

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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 “Creating Safe Scenes” 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, “Creating Safe Scenes”:

“Only about 7% of total U.S. healthcare spending has been for mental health.”

“Recognizing the source of your perceptions can help you de-escalate situations before they become a threat.”

“Mental health and substance use crisis calls, by their nature, are going to involve a longer scene time than trauma or medical calls.”

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’s history or past experience can help you better understand your patient and what they’re going through. For example, a patient who has experienced violence from their country’s military may distrust those in uniform. Survivors of sexual assault may be apprehensive of male providers. Understanding a patient’s 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’t just assume that their behavior is due to their mental health or possible substance use.

4. Remember the don’ts

  • Don’t raise your voice or attempt to talk over a patient
  • Don’t tell the patient to calm down
  • Don’t get defensive
  • Don’t argue with the patient
  • Don’t be judgmental about the patient’s actions

5. Explain what’s happening

Even if a patient isn’t responding to your attempts at de-escalation, explain everything you’re doing. It’s 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’t forget that you and your teams’ safety should be the No. 1 priority on scene. We all want to provide the best possible care, but remember you can’t 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:

This article was originally posted Sept. 9, 2020. It has been updated.

Marianne Meyers, BS, is a third-year medical student at the University of Washington School of Medicine interested in pursuing emergency medicine. Previously, she was a member of the Santa Clara University collegiate EMS squad where she received her B.S. in Public Health Science. Additionally, she has worked with the King County Public Health Department in Seattle, Washington studying EMT naloxone administration.