Psychiatric Emergency

Psychiatric Emergency
By Gary Wong
Senior Clinical Associate
Tung Wah College
What does “trauma” mean?
• Trauma is an emotional response to a terrible event like an accident,
rape or natural disaster.
• Immediately after the event, shock and denial are typical.
• Longer term reactions include unpredictable emotions, flashbacks,
strained relationships and even physical symptoms like headaches or
nausea.
(APA, 2013)
Influence of traumatic events
• You would be affected by those events which happened to you
personally.
• But sometimes, they may also affect you even in cases which you
witnessed or you learned about it happening to someone close to
you.
e.g. being infected by
Wuhan pneumonia
e.g. develop new

strategies/ lifestyle
抗逆 can return to premorbid

functioning
e.g. commit suicide
Wu, K. K., Tang, C. S., & Leung, E.

Y. (2011). Healing trauma: a
professional guide.
individual response to same
stimulus may have different signs
and symptoms
Cognitive
not for making diagnosis
- just for understanding
Spiritual Emotional
Signs &
Symptoms
Physiological Behavioral
Cognitive
may lead to
immediate risk
more severe, have
Distress mild reaction Dysfunction long-term effect
change in perception,
• Sensory distortion interpretation of stimulus • Suicidal/ Homicidal ideation
• Inability to concentrate • Paranoid ideation
• Difficulty in decision making • Persistent diminished problem-solving
• Sense of guilt capacity severe level of dumbing down
• Preoccupation with the event • Dissociation disconnected from reality
• “Dumbing down” 地 • Disabling guilt
• Confusion change in cognition, belief • Hallucination
• Inability to understand the consequence of • Delusions
behaviors
• Persistent hopelessness/ helplessness
Emotion
Distress Dysfunction
• Anxiety • Panic attacks
• Irritability/ Anger • Infantile emotions in adults
• Mood swings (Regression) act as a child
• Depressed • Immobilizing depression

• Fear/ Phobia/ Phobic avoidance • PTSD signs & symptoms
• Grief
Behavioral
• Impulsiveness • Violence
• Risk-taking
• Excessive eating
• Antisocial Acts
• Alcohol/ drug use • Abuse of others
• Hyperstartle speech become startling • Diminished personal hygiene
• Compensatory sexuality the presentation is understandable
• Sleep disturbance
• Immobility (Psychomotor retardation)
• (Socially) Withdrawal
• Family discord
• Crying spells
• Hypervigilance
• 1000-yard stare
Physiological
• Tachycardia or Bradycardia • Chest pain
• Headaches • Persistent irregular heartbeat
• Hyperventilation • Recurrent dizziness
• Muscle spasms • Seizure
• Psychogenic sweating • Recurrent headaches
• Fatigue / Exhaustion • Blood in vomit, urine, stool or sputum
• Indigestion, Nausea, Vomiting, Loss of • Collapse/ loss of consciousness
appetite • Numbness/ paralysis (arms, legs, face, etc.)
• Inability to speak/ understand speech
Spiritual
• Anger at “God” • Cessation from practice of faith
• Withdrawal from faith-based • Religious hallucinations or
community delusions
• Crisis in faith
similar term qualification is needed
Crisis Intervention (Mental Health First Aid)

• A short-term helping process
not a cure
• An acute intervention designed to alleviate the impact of traumatic

event
• It is NOT a psychotherapy.
Three Very Critical Questions
Is this a genuine psychiatric crisis?
Should the individual need to be hospitalized?
Should the police be called to help?

suddenly leave alone
Is this a genuine psychiatric crisis? - may be gone playing
or relapse -> may not

regard as a crisis
• If the client experiences active symptoms of mental illness……

• e.g. persecutory delusions, severe depressive moods and self-neglect……..
• If the severity is not approaching self-harm or dangerous to
others…….. the situation has threat to self
and others?
• Immediate intervention may or may not be required.

Should the individual under “crisis” need to be hospitalized?
捉人入醫院 -> medical term
determine the need
打爛俬? -> may - 黑警 may challenge the need
• Danger to self or others. e.g.
not a crisis but help 行使適當武力
- 消防破門
• Lack of monitoring supportive network.
• Unable to resolve the crisis even with adjustment in medication or
close supervision.
• Family members provoke client intentionally or unintentionally.
Should the individual be hospitalized – other considerations
• Discuss with client and carers.

• Prefer voluntary admission.
• Compulsory admission as last resort.
Should the police be called to help?
• Danger to self or others exists, which includes potential harm to the

workers.
• Client has recently attempted to harm himself/herself or has recently
acted violently towards others.
• Client became emotional and unpredictable, e.g. under the influence
of drug or alcohol.
Should the police be called to help? – other considerations
• Gain consent from carers.

• Explain to client and carers after settling the incident.
Working with Family
• Be calm and supportive
• Decide whether to involve both family members and client in the
interview/ intervention
• Help family members express emotions during and after the crisis
• Assess whether it is necessary to temporarily separate the client from
family members
• Help family members develop a contingency plan for managing the
crisis
Handling Strategies
• De-escalation
• Calm and supportive tone
• Basic counseling skills, e.g. empathy, active listening, attending skills, other
non-verbal communication skills, etc.
talk-down -> de-escalation
• Help the client express his/her anger and frustration of emotions
• Avoid arguing
Communication Structure
Closed-end questions to establish facts

emotion S tablization
needs, concerns A cknowledge
on both OT & client's perspective Open-ended
to have understanding of actual
situation
F acilitate understanding questions to probe
and explore
identify whether the
coping is effective E ncourage effective coping
give hope R ecovery
Paraphrase / Closed-end questions to summarize
R eferral and to provide directives
Tips for Handling Psychiatric Emergency
• Know the client well
• Good rapport
• Teamwork
• Communication channel
• Get emergency support ready
“Don’ts” during Individual Crisis Intervention
• Don’t argue • Don’t say: it is impossible for us to
• Don’t minimize problem • I know how you feel. understand the extreme feeling
- theoretical background • It’s not so bad.
• Don’t provide any - this can help you for xxx... • This was God’s will.
psychotherapeutic interpretation • God won’t give you more than you
• Avoid paradoxical intention can handle. (Unless he/she share the
same faith with you.)
• Avoid confrontation • Others have it much worse.
• You need to forget about it.
• You did the best your could. (Unless
he/she told you so.)
• You really need to experience this
pain.
The Mental Health of a
Mental Health Worker
• Self-awareness and
understanding
• Be true to yourself
• Personal traumatic experience
• Effective coping strategies
• Empty the “trash bin” regularly

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Psychiatric Emergency

e.g. develop new

抗逆 can return to premorbid

e.g. commit suicide

Wu, K. K., Tang, C. S., & Leung, E.

• Depressed • Immobilizing depression

Crisis Intervention (Mental Health First Aid)

• An acute intervention designed to alleviate the impact of traumatic

Is this a genuine psychiatric crisis?

Should the individual need to be hospitalized?

Should the police be called to help?

or relapse -> may not

• If the client experiences active symptoms of mental illness……

• Immediate intervention may or may not be required.

• Discuss with client and carers.

• Danger to self or others exists, which includes potential harm to the

• Gain consent from carers.

Closed-end questions to establish facts

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