"Crisis is a perception of an event or situation as an intolerable difficulty that exceeds the person's resources and coping mechanisms" (Gilliland & James, 1997).
Basic Crisis Theory: Since Lindemann's (1944, 1956) seminal contribution of a basic crisis theory stemming from his work in loss and grief, the development of crisis theory has advanced considerably. Lindemann identified crises as having: (1) a period of disequilibrium; (2) a process of working through the problems; and (3) an eventual restoration of equilibrium. Together with the contributions of Caplan (1964), this work evolved to eventually include crisis intervention for psychological reactions to traumatic experiences and expanded the mental health field's knowledge base in applying basic crisis theory to other types of crises experienced by people.
In addition to recognizing that a crisis is accompanied by temporary disequilibrium, crisis theorists identify the potential for human growth from the crisis experience and the belief that resolution may lead to positive and constructive outcomes such as enhanced coping abilities. Thus, the duality contained in a crisis is the co-existence of danger and opportunity (Gilliland & James, 1997). One part of the crisis state is a person's increased vulnerability and reduced defensiveness. This creates an openness in people for trying different methods of problem-solving and leads to change characterizing life crises (Kendricks, 1985).
Expanded Crisis Theory: While expanded crisis theory, as we understand it today, merges key constructs from systems, adaptational, psychoanalytic and interpersonal theories (Gilliland & James, 1997), the advent of systemic thinking heralded a new way of viewing crisis states. By shifting away from focusing exclusively on the individual in crisis to understanding their state within interpersonal/familial relationships and life events, entry points and avenues for intervention significantly increase. Systems theory promotes the notion that traditional cause and effect formulations have a tendency to overlook the complex and difficult to understand symptomology often observed in people in crisis. Especially with younger populations, crisis assessments should occur only within the familial and social context of the child in crisis.
More recently the ecological perspective is gaining popularity as it evolves and develops into models of crisis intervention. From this perspective, crises are believed to be best viewed in the person's total environmental context, including political and socio-economic contexts. Thus, in the United States, mobile crisis teams primarily responding to adult populations use an ecological model. Issues of poverty, homelessness, chronicity, marginalization and pervasive disenfranchisement characterize the client population served (Cohen, 1990).
Ecocsystem Theory: Most recently an ecosystem theory of crisis is evolving to explain not only the individual in crisis, but to understand those affected by crisis and the ecological impact on communities. For example, the devastating rate of suicide and attempted suicide in Inuit youth reverberates through their communities on multiple levels. Ecosystem theory also deals with larger scale crises from environmental disasters (e.g. oil spills) to human disasters (e.g. Columbine school shootings).
Applied Crisis Theory: Applied crisis theory encompasses the following three domains:
1) Developmental crises which are events in the normal flow of human growth and development whereby a dramatic change produces maladaptive responses (e.g., birth of a child, retirement);
2) Situational crises which emerge with the occurrence of uncommon and extraordinary events which the individual has no way of predicting or controlling (e.g., traumatic event, sudden illness) and;
3) Existential crises which refer to inner conflicts and anxieties that relate to human issues of purpose, responsibility and autonomy (e.g., middle life crisis).
Each person and situation is unique and should be responded to as such. Therefore, it is useful to understand the crisis from one or more of these domains in order to understand the complexities of the individual's situation and to intervene in more effective ways. One would also tend to see a younger population with developmental and/or situational crises (Gilliland & James, 1997).
Stages of a Crisis
In order to articulate the elements of a responsive mobile crisis service a conceptual framework of the stages of crisis is presented. There is agreement in the literature that most crisis interventions should last about one to six weeks (Caplan, 1964; Kendricks, 1985). This suggested time frame is based on identifiable stages of a crisis. Frequently cited in the literature (Gilliland & James, 1997; Smith, 1978) is Caplan's four stages of crisis:
Stage 1: A precipitating event or condition produces tension in the person(s) at which time customary problem-solving strategies are attempted.
While others have proposed slightly varying stages, there are commonalties in understanding that crises are time-limited, have a beginning, middle and end, and that intervention early in a crisis can produce stabilization and a return to the pre-crisis state. No intervention, or inadequate intervention, can result in chronic patterns of behavior that result in transcrisis states (Gilliland & James, 1997).
Transcrisis states contain the appearance of resolution but the recurrence of the crisis usually indicates that the crisis has not been adequately addressed. This manifests in repeated hospital admissions or numerous visits to emergency rooms.
In summary, overall goals specific to mobile crisis services cited by service providers include: providing timely treatment in the least restrictive environment; utilizing community-based treatment alternatives rather than in-patient treatment; hospital diversion when appropriate; hospital admission when necessary; increasing client functioning; providing medication/symptom management; involving supportive family members; and assisting clients in obtaining service from other programs for on-going treatment.
Ramona Alaggia, Ph.D.
Caplan, G. (1964). Principles of preventative psychiatry. New York: Basic Books.
Cohen, N. (1990). Psychiatry takes to the streets: Outreach and crisis intervention for the mentally ill. New York: The Guilford Press.
Gilliland, B. & James, R. (1997). Crisis intervention strategies. Scarborough: Brooks/Cole Publishing Co.
Kendricks, J. (1985). Crisis intervention: Contemporary issues for on-site interveners. Springfield, Ill.: Charles C. Thomas Publishers.
Lindemann E. (1944). Symptomology and management of acute grief. American Journal of Psychiatry, 101, 141-148.
Lindemann E. (1956). The meaning of crisis in individual and family, Teachers College Record, 57, 310.
Smith, L. (1978). A review of crisis intervention theory. Social Casework, July.