Evolution of Crisis Intervention and Its Impact on Society

Crisis Intervention:

Crisis situations are usually sudden, unexpected, life-threatening time-restricted incidents that may overpower a person's ability to react adaptively. During these critical incidents, the extreme events may contribute to individual crises, traumatic stress, and even Posttraumatic Stress Disorder. Generally, a crisis can be described as an incident that occurs when people are confronted with issues or problems that cannot be solved. The irresolvable incidents contribute to an increase in anxiety, tension, inability to operate for extended periods, and a successive state of emotional unrest. In the past few years, there have been various major events that have impacted the development and growth of crisis intervention. Some of these major events have occurred in the past 30 years and contributed to the evolution of crisis intervention.

Definition of a Crisis:

As previously mentioned, a crisis can be described as an incident that occurs when people are confronted with problems or situations that cannot be solved. These problems or situation are usually accompanied by emotional unrest, anxiety, tension, and seeming inability to function effectively (Dass-Brailsford, 2007, p.94). In other cases, a crisis is defined as an incident or event considered as unbearably difficult that is beyond a person's available resources and coping techniques. This period is characterized by a period of psychological disequilibrium, which cannot be resolved using common coping mechanisms.

Generally, crisis events have various characteristics including perception of the event precipitating the incident as threatening, seeming difficulty to change and lessen the effect of stressful conditions, and increased tension, fear and confusion. The other characteristics are high level of biased discomfort and rapid shift to an active crisis state from a state of discomfort. Some of the most common examples of crises include death or loss of a loved one, unemployment, natural disasters, financial challenges, physical illness, an accident, unexpected pregnancy, and divorce or separation.

Development of Crisis Intervention:

Crisis intervention can basically be defined as the provision of emergency psychological attention and care to people affected by sudden, stressful situations. The main goal of crisis intervention is to help victims of such circumstances to return to adaptive levels of operation and lessen or prevent probable negative effect of psychological trauma from the incident. Crisis intervention primarily provides opportunities for such individuals to learn new coping methodologies through identifying, organizing, and improving the existing coping mechanisms.

Crisis intervention has mainly developed from disaster response and military literature or narrative in the early 20th Century. This mechanism commences immediately in attempts to restore traumatized individuals to normal operating levels in order to stabilize them and help mobilize resources and support networks. The procedures used in crisis intervention have developed from researches on grieving in 1944, military literature in 1947, and focus on community mental health programs that are geared towards primary and secondary prevention (Flannery & Everly, 2000, p.120). However, the field of psychological crisis intervention has been in existence since early 1900s. The 1944 studies on grieving were carried out by Erich Lindemann after a major nightclub fire while military literature in 1947 examined the three basic principles in crisis work-immediacy of intercessions, closeness to the event's occurrence, and expectations that the victims would resume to normal operations. In 1964, Gerald Caplan focused on community mental health initiatives or measures that were based on primary and secondary prevention.

Notably, intervention is mainly a natural consequence of the specific nature of the critical event. Therefore, crisis intervention should be parallel to conceptualization of the critical incident or the given problem. Based on the concepts developed by Caplan in 1964, crisis intervention has primarily been considered as urgent and acute psychological intervention to a sudden, stressful intervention. Some of the initial crisis intervention strategies were based on immediacy, proximity, expectancy, and brevity. These strategies were adopted to achieve four major goals i.e. stabilization, mitigation, and restoration. Stabilization focuses on stopping escalating suffering while mitigation is lessening acute signs or symptoms, and restoration is promoting adaptive autonomous functioning or facilitating access to high degree of care.

Since the 1900s, the field of crisis intervention has developed concepts and practices that focus on civilian populations and individuals exposed to harmful situations such as the military. Moreover, disaster mental health that targets first responders is a field of practice that has developed during the same period. The development of this field of crisis intervention that targets first responders was influenced by various factors i.e. The realization of occupational risk these individuals are exposed to, emergence of critical incident stress management, and the increase in global terrorism (Castellano & Plionis, 2006, p.327).

An Event that has Led to Development of Crisis Intervention:

Based on the historical perspective of crisis intervention, the strategies have constantly evolved through various critical incidents that have happened from time to time. An example of a major event that has taken place in the past 30 years and led to the evolution of crisis intervention is the 9/11 terror attacks. These attacks galvanized public attention across the globe on how populations respond to crises or disaster and how to effectively intervene to lessen the psychological, behavioral, and operational effect on victims. The effect of the attacks on the field of crisis intervention is that they contributed to extensive research and experience that resulted in the establishment of new ways of responding to crises. Actually, the aftermath of these attacks was characterized by the establishment of evidence-based and evidence-informed regulations and initiatives to promote the design and implementation of crisis intervention measures that focus on mental health after a critical incident has occurred. The focus on mental health has been applied to the new field of crisis intervention for first responders who were traditionally resistant to looking mental and/or behavioral health services. This is primarily because first responder personnel have been comfortable dealing with the issues of others instead of their own problems.

One of the major development of crisis intervention in the aftermath of 9/11 terror attacks is the establishment of Psychological First Aid (PFA) that focuses on meeting the mental health needs of populations following the occurrence of a critical incident or crisis. As a model of practice endorsed by the Institute of Medicine, this form of crisis intervention seeks to provide information and education, peer support and comfort, speedy recovery, improved resiliency and mental health, and access to constant care (Castellano & Plionis, 2006, p.329). Consequently, the model is considered as a form of emotional first aid during crises.

The Psychological First Aid model was applied at the World Trade Center in the aftermath of the 9/11 attacks by the New Jersey State Police to help in providing rescue and recovery efforts. This law enforcement department was providing rescue and recovery 24 hours a day in 12-hr shifts for a period of 10 days before returning to their base. While the unit utilized this model to provide emotional support to its members following the impact of these efforts, Psychological First Aid is developed for civilians. The New Jersey State Police used the model in responding to the psychological needs of individuals who had been exposed to traumatic incidents during the attack.

Psychological First Aid consists of five stages that are used in the process of meeting the psychological needs of individuals after a crisis. The first step in this model is the assessment phase whose main goal is to provide immediate evaluation of mental health for individuals perceived to be at high mental health risks because of exposure to the crisis. The assessment phase helps in identification of the psychological or mental health needs of individuals who have been affected by the incident. This goal is achieved through the use of peer counselors who are involved in counseling the individuals to help determine their mental health needs. The peer counselors are usually law enforcement emergency personnel who are professionally trained to provide such services during a crisis. For instance, during the rescue and recovery efforts at World Trade Center after the 9/11 attack, the New Jersey State Police had a mental health tent with law enforcement personnel and clinical staff specifically trained in dealing with mental health issues during a crisis (Castellano & Plionis, 2006, p.329).

The second stage is the stabilization phase whose main objective is to provide comfort and peer support and accelerate the recovery and restoration process. Stabilization phase is characterized by provision of medical support and information and education. The first responders provide adequate information and education to the public on how to respond to the various dynamics associated with the crisis. At the same time, these professionals work in collaboration with medical personnel to provide treatment to victims in need of treatment. A suitable example of this phase during the 9/11 was when the New Jersey State Police conducted routine medical checkups on victims and first responders, ongoing spiritual leadership, and placed televisions in tents for acquisition of information.

The third stage in this process is the triage phase which focuses on promoting individual resiliency and provision of support. In order to achieve these goals, the triage phase involves the use of various strategies that are deemed appropriate and effective in the creation of a supportive environment that help individuals to cope with the incident and become more resilient. The supportive environment helps in ensuring that the affected individuals enhance their coping skills and mechanisms in dealing with the critical incident. During the 9/11 attacks, this unit provided opportunities for people to team up and achieve group cohesion that helped in establishing a supportive environment while promoting individual resiliency. As a result, many volunteers and crisis counselors from various parts in the country showed up and were willing to engage in dialogue with the victims and responders regarding their experiences.

Interactive communication phase is the fourth stage of Psychological First Aid that seeks to promote normalization i.e. return to normal functioning and restoration. Notably, crisis responders enable victims to return to normal functioning as soon as possible based on the experiences of the respective individual. In essence, normalization procedures are developed and established based on information received from the victim during interactions after the crisis. For the New Jersey State Police, this process involved providing materials and information regarding critical incident stress, preparing individuals for spiritual grounding, and enabling them to meet with their families and friends (Castellano & Plionis, 2006, p.330).

The final phase in Psychological First Aid as a development in crisis intervention is hotline phase that seeks to provide any necessary support t individuals after the crisis to ensure that they will not suffer from any recurring psychological distress. This stage helps in ensuring strengthening the normal functioning of the individual after the crisis through providing any necessary extra support. For instance, the New Jersey State Police initiated and maintained contact with these individuals as art of conducting follow-up after termination of the crisis intervention process.

Impact of Crisis Intervention on the Society:

Crises have traditionally had significant impacts on the society to an extent that some of them such as global terrorism have redefined the society. For instance, some crises over the past decade have made schools to become shooting fields, airplanes to become missiles, and office buildings to become major targets for criminal activities. The impact of crises on the society in the recent years is mainly attributed to the increase, frequency, and effect of these incidents. However, as crises have increased in frequency and had considerable impacts on the society, various initiatives have been undertaken towards a comprehensive crisis intervention model. The development of crisis intervention has also continued to have significant impact on the society in various ways.

One of the ways with which crisis intervention has impacted the society is through promoting increase and extent of peer support. Peer support can be described as a form of individual crisis intervention measure with an individual doing the same or a similar job. While peer support is not necessarily provided by counselors or therapists, it seems effective in cases where acute intervention techniques are insufficient in helping an individual (Clark & Haley, 2007). People in today's society have become increasingly sensitive and responsive to others in need of help during and after a crisis to an extent that they provide peer support. For instance, when Officer Marlene Loos from the New York Police Department, Suffolk County, was shot while responding to a disturbance, coworkers who had experienced similar traumas helped her the most and made it easy for her to cope with the situation.

Secondly, crisis intervention has helped people in today's society to identify the need for talking when experiencing a crisis. While it is easier for some people to talk about their experiences and receive timely help, others prefer to keep quite in attempts to deal with their emotional responses to critical incidents. Crisis intervention helps both victims and first responders to share about the events they experience and to develop successful and effective coping mechanisms. The findings of a study on 71 police officers conducted by Nancy Bohl, a police psychologist is an appropriate example of recognition of the need to talk. In this study, 40 police officers who attended a Crisis Incident Stress Debriefing were less depressed, angry, and anxious and had minimal post-trauma symptoms as compared to the rest who did not attend (Clark & Haley, 2007).