The mental healthcare arena is a wide landscape that has to bear the weight of huge, ever-growing needs. Mental illness and crisis are at an all-time high. It is being propelled by – in addition to plenty of other things – the current political climate, the worldwide stress caused by Covid and its continuing aftermath, rising costs and the scarcity of resources, and continuing barriers to adequate care for many portions of the population.
Mental health crises often follow a predictable pattern. This pattern can be observed in an individual’s personal experience with mental illness. It is also observable from a larger, public health vantage point. Diverse academic authorities and thought leaders have developed various models to make sense of this pattern.
Some divide the process into more or fewer steps and might emphasize or include different elements. Though a quick online search can help round out these ideas and provide alternative ways of thinking about this process, this article explores one simple framework to help explain the basic tenets of the phases of crisis in mental health.
Phase one: pre-crisis
Any story starts with a first hint that not all is well. The pre-crisis phase of a mental health saga is usually the point at which a first sign of trouble appears. Perhaps it’s an early warning sign or symptom. Perhaps it’s a jarring conversation or realization. Perhaps it is an observation made by a family member or close friend.
From a public health or populace perspective, it could be the first statistics indicating that mental health needs are beginning to exceed availability of care or an independent audit that reveals a lack in adequate or appropriate mental health services.
Phase two: crisis
A helpful definition for ‘crisis’ according to Merriam-Webster is ‘a situation that has reached a critical phase’. In the case of a mental health story arc, the crisis point is often when it becomes clear that an intervention is needed.
Individuals experience this phase of the process in myriad ways. It could be a moment when mental health gets in the way of being able to function in a way that one could in the past. Perhaps a budding mental health problem causes one to miss an important function, fail an important test, or lose a job. Perhaps family members leave. Perhaps one receives a clear diagnosis or doctor’s order.
Whatever the circumstances might be in an individual case, this step in the process usually changes the situation from an unknown to a known quantity.
From a public health perspective, the crisis point is a bit more nuanced. Perhaps a state of emergency is declared. Perhaps the mental health-related mortality rate spikes. A notable publication might draw attention to a growing mental health problem. Perhaps the municipality loses out on an important opportunity because of their mental health situation, or is fined or blacklisted by independent authorities.
Phase three: response
When a problem reaches a crisis point, some kind of action must be taken. The converse could prove devastating. Helping individuals initiate appropriate responses to mental health crises is a huge part of the mental healthcare response process. This phase involves many moving parts.
Education and awareness about mental health and appropriate responses can make a huge impact on helping people navigate their experiences effectively and respond in a way that may reverse their situation in time. Having appropriate resources in place to support individuals who need mental health aid often involves multi-faceted approaches that interweave government welfare programs, private or nonprofit aid organizations, the mobilization of individual and personal network support, and more.
Public health response programs will vary or look different depending on the nature of the crisis and the particulars of the population at hand. Providing effective mental health crisis support for a given population can prove a complex problem for public health officials to solve and might involve any number of initiatives or strategies.
Phase four: recovery (or resolution)
The recovery phase of mental health crises can vary widely in size, shape, involvement, and duration depending on the nature of the crisis in question. For instance, for diagnoses caught early, or for children that are much more resilient and malleable than adults, the recovery phase might take a relatively short amount of time and, in many cases, brings about full restoration to normal quality of life and healthy living. For other recovery processes, these results might be more tempered.
Public health strategies for achieving recovery states for mental crises that take place across populations usually take much longer and involve more nuance.
Healthcare providers must respond to complex mental health needs with innovative solutions, strong leadership, and future-focused thinking. Moving a population out of a mental crisis is an incredible challenge and must be navigated with intentionality.
Whether on an individual or public health level, mental health crises must be treated with proactive and robust attention to reach the recovery phase. As the public health scene struggles to meet the rising demand and need for mental health services, this area of healthcare will require an all-hands-on-deck approach as well as awareness and action on the parts of both individuals and healthcare providers to effectively combat growing mental health crises across our population.
Dennis Relojo-Howell is the managing director of Psychreg.
