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Mental health crisis management for sports medicine professionals

This is an excerpt from Acute and Emergency Care in Sports Medicine 2nd Edition by Katie Walsh Flanagan,Patrick Sexton.

By Jennifer Ostrowski

Management of Mental Health Crises

The National Alliance on Mental Illness (NAMI) defines a mental health crisis as a situation in which a person’s behavior puts them at risk for hurting themselves or others or prevents them from being able to care for themselves or function effectively in the community.⁵⁹ The behaviors of a person experiencing a crisis can be unpredictable and can change without warning. The person may not be able to clearly communicate their feelings or emotions and may find it difficult to understand what others are saying.

It is important to empathize, stay calm, and try to de-escalate the crisis. De-escalation involves conveying a sense of calm and genuine interest in the patient’s needs and wishes. The goal is to build rapid rapport and a sense of connection with the agitated individual.⁷⁴ It is important to understand that agitation and aggression are not the same as violence. To be clear: Violence is not a symptom of mental illness, and research suggests there is little relationship between mental illness and violence when substance use is not involved.⁷⁷ In addition, individuals with mental illness are more likely to harm themselves than to harm others.⁷⁸

De-escalation in the context of a mental health crisis refers to the use of a set of techniques to defuse a situation in which someone is experiencing extreme emotional distress, anger, or agitation with the aim of preventing further escalation and potential violence. De-escalation involves the use of verbal and nonverbal communication strategies to create a safe and supportive environment.⁷⁹ Strategies recommended by the NAMI are included in the Clinical Tip sidebar.⁵⁹ Bystander intervention and its associated de-escalation strategies are discussed later in this chapter. As with any emergency, if the HCP does not feel able to de-escalate the crisis or keep the person or others safe, they should seek help from a professional or call 9-1-1 immediately.

Each mental health crisis discussed in this section includes a 3-step action plan: Ask, Inform, Refer. When appropriate, psychosocial strategies or emergency techniques that are within an AT’s skillset are also included. Essential components of mental health crisis management include the following⁵⁷:

• Approach the person.
• Assess the situation.
• Assist with any crisis.
• Listen nonjudgmentally.
• Offer support.
• Offer information.
• Encourage the person to get professional help.
• Encourage other supports (including social supports and self-help strategies).

The following sections discuss specific mental health emergencies and crisis management. Prior to discussing an individual’s mental health concerns with others, HCPs should be sure to familiarize themselves with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).⁸⁰ Providers in education settings should be familiar with the Family Educational Rights and Privacy Act of 1974 (FERPA). FERPA requires schools to protect student information from unauthorized disclosure.⁸¹ HIPAA has 3 rules:

• Privacy Rule: This rule safeguards protected health information.
• Security Rule: This rule requires administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.
• The Breach Notification Rule: According to this rule, a breach of protected health information must be reported to the U.S. Department of Health and Human Services as soon as possible (within 60 days of discovery).

Panic Attacks

A panic attack is an abrupt surge of intense fear or dis-comfort that reaches a peak within minutes. Panic attacks are associated with heart palpitations, a pounding heart, or an accelerated heart rate (HR); sweating, trembling, or shaking; sensations of shortness of breath or choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or faint; chills or heat sensations; paresthesia; derealization (a feeling of unreality) or depersonalization (a feeling of being detached from oneself); fear of losing control or “going crazy”; and fear of dying.¹ Each year approximately 11% of the population experiences a panic attack, and approximately one-third of people will experience at least one panic attack in their lifetime; however, very few people (2%-3%) go on to develop panic disorder. Panic attacks come on suddenly and unexpectedly, typically with no known trigger.

Crisis Management for Panic Attacks

• Ask: “Are you experiencing a panic attack?” “Have you had panic attacks before?” “Has this happened before?” “Would you like help?” “What do you think started this?” “What has worked for you before?” (See figure 16.1 for a crisis management decision tree for panic attacks.)
• Inform: Provide information (“You’re caught in a cycle of negative thoughts and body responses”). Validate (“This is scary, but it is only temporary”). Reassure (“We will get through this together”). Do not make false promises.
• Refer: “Have you ever talked with anyone about your panic attacks?” “Would you be interested in working with someone who could help you manage the symptoms of a panic attack?”
• Psychosocial strategies: Use breathing strategies (e.g., diaphragmatic breathing, box breathing)82,83 or cognitive restructuring strategies (e.g., thought stopping, reframing, countering).^84-86

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