7. Crisis management

Introduction

In this chapter, we will give an introduction to the process of crisis management in peer support work. As peer supporters, we interact with people who are experiencing various struggles or different amounts of stress in their lives. Sometimes the amount of stress can be so overwhelming that the situation constitutes a crisis or a traumatic experience. In such cases, the demands of the situation exceed the coping resources the person is able to use. It is also important to remember that we as peer supporters can also experience crises ourselves and we should be prepared for them!

7.1 What is a crisis?

In the case of a psychological crisis, we are talking about a change of life, event or experience that needs additional adaptation and coping. The demands of the situation exceed the coping resources the person has or is able to use. It is something that is very much out of the ordinary.

A crisis:

Is unexpected
Relates to a real or a perceived threat and a sense of unknowing, uncertainty
Has strong influence on people and brings about strong feelings
Has a possible traumatic influence

The severity of the crisis is closely related to the person’s previous experiences and resources. What may feel like a moderately complicated situation for one person, may bring upon an intense crisis reaction in another. What is more, the same situation may affect the same person very differently at different times in life.

What is the difference between “usual” stress and a crisis?

Stress reaction is our body’s state of arousal that arises in a situation of threat, challenge or change. It is a universal reaction, it’s not situation-specific, and it’s meant to prepare us for the challenge ahead, so that we are able to use our resources – so that we can concentrate and do what’s demanded. The “usual” stress is the everyday stress that motivates us to act, and is an important and useful part of problem solving and decision-making. Intense levels of stress has its dangers when it starts to accumulate (and it may result in a crisis in the long term), but it is different from a crisis.

A crisis, on the other hand, is a situation of extreme stress. In the case of the crisis, the person’s previous coping mechanisms are not enough to maintain a feeling of control over the situation. In a crisis, we feel that our physical health, mental well-being or social status is in danger. As shown in the previous paragraphs, what constitutes a crisis can be rather individual, but some common possible triggers can be pointed out.

Possible triggers of crisis

Death of a close person, suicide in close circle;
Serious illness of the person themself or in their close circle;
A behaviour that brings shame or confusion, like drunk driving, improper behaviour (also on the Internet), being imprisoned;
Unemployment, economic difficulties;
Traffic accidents, fire, natural disasters;
Violence in close relationship, at home, on the street;
Sexual violence;
Being the victim of a robbery, theft, attack;
Narrow escape from an accident;
Worries associated with being a parent like fertility problems, miscarriage, the illness of a child;
Difficulties in partnership like divorce or unfaithfulness;
Moving to another town or country.

7.2 Peer crisis and personal crisis

An important question to be answered is: who is the person experiencing the crisis? If it’s the person we are supporting as a peer supporter, we are talking about a peer crisis. If it’s the case of us, the peer supporter experiencing a crisis, we are talking about a personal crisis. The ways to manage these situations and our reactions are different, whether it’s one or the other, but prioritising health, safety and receiving adequate help are the core for both cases.

Peer crisis

In order to protect the health and wellbeing of the peer that we are supporting, it is important to know about coping with stress, crisis and traumatic reactions. It is even more important to be aware of our skills and resources to provide adequate support. Peer supporters have different backgrounds – some may have education in relevant fields (e.g psychology, social work, medicine), whereas some peer supporters have more practical experiences and may not yet have too much training on mental health topics.

In providing peer support, especially during crisis and trauma situations, it is necessary to acknowledge that seeking (further) professional mental health aid may be needed. As peer supporters, in addition to providing empathic listening and empowerment, we can be of assistance while seeking further help. We can do so by providing information and sharing our own experience – but that is something to be done mindfully. A mental health first aid or a psychosocial first aid framework may be a useful tool to a peer supporter, especially in crises. We will introduce that topic briefly later in this module.

It’s always good to ask first, if the peer would like to hear your perspective, whether it is about your personal experience or information about help that might be useful for the peer. In the case of a crisis or a traumatic situation, it is probably not the time for personal stories or lots of information – we first need to address the practical questions of being (and feeling) safe. Focus on providing safety and comfort first, and keep the information simple, factual and delivered in a caring manner.

You can also check our e-learning chapter 2.5 where we discuss trauma-informed peer support.

If you are supporting a peer in a crisis, be very mindful of your own resources and take care of your wellbeing. That is essential for both you and the peer!

If you forget yourself or sacrifice your boundaries, you are at a great risk of burnout and that can make you unable to support them, thus making the situation harder for the peer as well. Metaphorically, you shouldn’t light yourself on fire to keep others warm, and that is especially the case in crises.

Personal crisis

As peer supporters, we are also human and as such, we can experience crises in life. When we are experiencing a crisis, it is essential to take a break in providing support. That is because in that situation, we need to prioritise our own wellbeing and get support for ourselves. As it’s often said – you cannot pour from an empty cup!

If we have experienced a traumatic event or have neglected our needs to the point where we feel overwhelmed and unable to cope, it is essential that we speak out and seek help. If you’re working in an organisation, let your manager (or the person most fitting for it) know as soon as possible. You need to take time off from supporting others to recover. You may find support from your team – spending time with caring people can be very helpful. So, you can still come to the workplace if being in that familiar surrounding supports you, but do keep in mind that you should be on the receiving end of emotional support, not the one providing it to others.

Here are some questions to help you assess, whether you are experiencing a crisis:

Are you feeling a loss of control or having difficulties with coping with daily life and tasks?
Are you experiencing difficulties with eating, sleeping or caring for your hygiene?
Have you recently experienced an unexpected event that has brought on strong emotions or complete numbness?
Do you feel that your usual coping methods are not helpful (enough) or you are unable to practice them?

If you have answered “yes” to at least one of the questions, this may point to a need to further look into your state of well-being. If you answered two or more questions with “yes”, it is rather possible that you are experiencing a crisis. Seek out help as soon as possible – from a close friend, partner, mental health specialist or a crisis worker.

Further tools and tips for both assessing your self-care needs and communicating those to other people can be found in the module for self-care in this course. If you find yourself in the “red light zone” within the traffic-light system, it’s most definitely time to take action to regain your wellbeing.

7.3 Strategies to offer support in a crisis

There can be several ways to approach offering peer support. Certainly, as each peer supporter is an individual with their own strengths and communication styles, every supportive connection will have its own dynamics. Nevertheless, it is often beneficial to have some guidelines in order to build a supportive and stable connection.

Having a crisis plan

The main goal of having a crisis plan is that when the crisis occurs, you don’t need to think – you can just act according to the plan. The necessity for that, of course, is making the plan beforehand. In an organisation, it is tremendously beneficial to develop concrete, step-by-step crisis plans for possible crisis situations that may have a large effect on the team or the organisation. Examples of such situations (especially relevant to offering peer support) can be illness or relapse among key persons in the team, death (including suicide) in the organisation or among the peers that we have been supporting, sudden financial or other threats to the organisation, etc. What is more, people can develop personal crisis plans to difficulties they can anticipate (e.g relapse regarding health).

For developing a crisis plan, it’s good to do it in a team. First, a scenario for the crisis is chosen. Then think about who is most probably affected by the situation – who are the people/groups most probably in need of support? Who are the people that can offer that support, how can we reach them and what agreements can we make for that already? How do we connect the supporters and the people needing support?

Another tremendously important topic in crisis is information – it’s often even fair to say that crisis management is first and foremost information management. Who needs to hear about the situation? In what order should we let those people know (e.g. the board, the team, the whole organisation)? It’s important to provide information to those influenced by the situation and the information should be stated in a neutral, brief, factual, but still caring and humane manner. Often, it’s good to provide information together with resources for reaching further help.

Exercise

If you are working in an organisation, find out what are the main practices in your organisation for managing crises.
Are there any concrete step-by-step crisis plans formulated for certain situations?

Check our toolkit for a guide in creating a crisis plan and an example plan.

Mental Health First Aid

One helpful set of guidelines for peer supporters can be mental health first aid – the help provided to a person who is developing a mental health problem, experiencing a worsening of a mental health problem, or in a mental health crisis. Mental health first aid is given until appropriate professional help is received or the crisis resolves (You can read a brief history of MHFA here).

It is important to always tailor your support to the needs of the person you are helping. These guidelines are a general set of recommendations only and most suitable for providing mental health first aid in high-income countries with developed health systems. Expert consensus panels that have informed these guidelines include people with lived experience of mental illness, their caregivers, and mental health professionals. These guidelines can be downloaded from this page, where a wide array of topics have been covered, such as supporting someone with depression, eating disorders, experiencing suicidal thoughts or behaviours and many more mental health concerns. What is more, consideration is given on further important aspects, such as providing support for deaf people, adolescents, LGBTQI+ people, etc. There is also a large collection of guidelines for helping people with mental health problems and financial difficulties. As you see, there is material that is outside the scope of this course, but can be used in order to support growing your competences as a peer supporter.

Mental Health First Aid: Action Plan

Here’s a short video that introduces the 5 steps of mental health first aid action plan:

Before starting to give mental health first aid, it’s important to ask yourself whether you have the resources to offer support? Check your time, wellbeing and other resources (see module 8 on self-care). Only then, if you are certain that you have the needed resources, can you move on to the next steps.

Approach and evaluate the situation – is there any risk of suicide or harm?
Listen without judgement
Give reassurance
Encourage use of professional help
Encourage self-help and other supportive strategies

After you have given mental health first aid, it would be a good time for some self-care as supporters, because these emphatic and supportive discussions naturally take up mental energy.

Psychological (or psychosocial) first aid

Another beneficial framework for crises can be psychological (or psychosocial) first aid (PFA). That is an even more practical approach than the mental health first aid, as its focus is in taking care of the basic needs after a traumatising event. The World Health Organisation has created materials on this topic (in several languages) that can be found and downloaded from here. These guidelines are a general set of recommendations developed in order to have widely agreed upon psychological first aid materials for use in low and middle income countries.

According to WHO’s guide, psychological first aid describes a humane, supportive response to a fellow human being who is suffering and who may need support.

PFA involves the following themes:

providing practical care and support, which does not intrude;
assessing needs and concerns;
helping people to address basic needs (for example, food and water, information);
listening to people, but not pressuring them to talk;
comforting people and helping them to feel calm;
helping people connect to information, services and social supports;
protecting people from further harm.

It is important to keep in mind that although PFA involves being available to listen to people’s stories, it is not about pressuring people to tell you their feelings and reactions to an event. In offering PFA, we don’t ask people to analyse what has happened to them or necessarily have detailed discussions about the event that caused the distress.

PFA involves factors that seem to be the most helpful to people’s long-term recovery:

feeling safe, connected to others, calm and hopeful;
having access to social, physical and emotional support;
feeling able to help themselves, as individuals and communities.

Similarly to MHFA, it starts with asking yourself whether you have the resources to offer support? Check your time, wellbeing and other resources (see module 8 on self-care). Only then, if you are certain that you have the needed resources, can you move on to the next steps.

The main steps in the PFA framework are Look, Listen and Link. Each of the main steps has a few points to pay attention to. We have slightly adapted the material to fit better for the context of peer support setting, as PFA is often used in large humanitarian crises (e.g. war, natural disasters, accidents) and thus caters most to those specifics.

Look:

Check for safety. Choose an environment where you can talk privately.
Check for obvious urgent basic needs (e.g needing emergency medical help, having torn clothes etc)
Check for serious distress reactions (e.g being extremely upset, not able to move on their own, not responding to others, or in shock).

Listen:

Approach people who may need support and make contact
Ask about people’s needs and concerns.
Listen to people, and help them feel calm.

Link:

Help people address their basic needs and access services.
Help people cope with their problems.
Give information that is relevant to the situation or their problems.
Help people connect with their loved ones and social support.
Follow up if you promise to do so!

Similarly to MHFA, after offering psychological first aid, it is important to take care of ourselves. How to do that is also the topic of our next module.