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The First Things To Do When You Or Someone You Love Is In Crisis

Understanding the patterns of one's mental illness and creating an action plan can help individuals & families manage – and even prevent – a crisis.

Ken Duckworth:  If you’re experiencing a mental health crisis, I think the first thing to do is figure out what you need. Right? So, if you’re having trouble with your own safety, you’re really thinking about killing yourself, you need to get help. And you need to see a professional, or you need to go to an emergency room. Not everything can be done on a self-help basis. That said, self-help and self-management have become crucial aspects of helping people do well. So the idea over time is to learn as much as you can by joining groups like the National Alliance on Mental Illness, to educate yourself, to participate in your own care in an active way. And it’s not something like, the doctor is giving you a medicine, it’s all forgotten. You learn about your condition, you learn about the stresses, you learn about what it takes to help you live the best way with it. Once you understand that, the crisis that you’re dealing with is probably known to you, and you should have a framework for how to address future problems. So the key thing about thinking about a crisis is how to get ahead of it, how to learn from prior vulnerabilities, and how to enroll people in your life to help you anticipate it in a way that you can accept their gentle feedback.

When a person doesn’t want help, it generates a tremendous challenge in all the people who care about them. How do you help a person who isn’t particularly motivated? Or how do you deal with a person who feels ashamed of their symptoms? Because when you ask a person, do they need help, the vulnerability that they may feel, the shame that they may feel about knowing that they’re struggling, is one of the things that you’re gonna be battling with. So the first thing I encourage them is to be gentle with themselves. This is not an easy thing you’re trying to take on. Then I encourage people to think of overlapping Venn diagrams. You might see: a psychotic illness, a problem hearing voices, difficulty with functioning, and having trouble getting out of bed. They might see: getting out of bed is a problem, and I wish I had more to do. So I encourage people to ignore battling about their diagnosis or their symptoms, and focus on the things that the other person wants to do. I wish I could get out of bed, and I wish I could do more. By work, by starting with things you can agree upon, and building upon them, that’s typically a good way to get started. You will probably need professional help, though. And professionals deal with this hard topic all the time.

In the Wellness Recovery Action Plan, and with any good caregiver, the purpose of the work is to identify patterns for you that you can anticipate future vulnerabilities. Some patterns repeat themselves. So, if you have depression that occurs in the winter, or if you have bipolar episodes in the context of relationship distress, these become predictable phenomena. The idea of creating an anticipation of your risk for crisis is actually part of the answer to dealing with a crisis. So the idea would be to understand, if it’s seasonality, relationship changes, medication changes, that are risks for you, and then to identify a series of things that you can do to minimize your risk. Is it aerobic exercise? Is it having a social role? Is it participating in helping other people as a peer and giving yourself a sense of meaning? These are the things that we find over and over help people contend with reducing their vulnerability. So the earlier a person gets help, the better their chances become. People can recover and live great lives.

One place to get help is the NAMI helpline. The NAMI helpline is staffed by people who are living with mental illnesses successfully and by their family members. The number is 1-800-950-NAMI.

What should you do when a mental health crisis strikes? Dr. Ken Duckworth of the National Alliance on Mental Illness reveals how understanding the patterns of one's illness and creating an action plan can help individuals and families manage – and even prevent – a crisis.

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An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

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  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
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  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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