Psych Crisis

Philosophy and Values

  • We’re pragmatic: We find practical, social and emotional skills more useful than credentials and degrees for helping clients
  • We respect everyone’s right to freedom: We work to avoid involuntary hospitalisations when they are likely to be unhelpful or traumatic
  • We’re observant: We’ve discovered that what each person needs to recover is specific to their situation; more than a diagnosis, we relate to the person in their world to understand how best to help
  • We’re rigorous: We track metrics to improve our program, even while we understand that metrics can be incomplete or misleading. We keep working to make our metrics more useful and more accurate.
  • We tolerate appropriate risks: We know that rushing to avoid risks can create more damage in the long-term, to self-confidence, to trust, and to relationships. We take things slow, and work to build trust in and with our clients.

What We Do

In order to reduce the distress patients and their loved ones feel when reaching out for help during a mental health crisis, we’re training and deploying teams who are intensively trained in de-escalation and building rapport, based on the nationally-recognised CAHOOTS model operating in Eugene, Oregon since 1989.

We respond to people experiencing suicidal urges, psychosis, mania, panic attacks, drug-induced altered states, and overdoses. We respond to people having a hard time on the street. In each case, there are things that help the person and those around them get through the crisis, and things that would make it worse–and we work to listen as deeply as possible so we can figure out together what to do about it. 

  • We respond to more 911 calls than other mobile crisis teams
  • We spend most of our time on each call listening and letting the person we’re responding to feel heard
    • We start ordinary conversations, compared to most other mobile crisis teams, who read formal assessments from checklists
    • We train in regular sessions to improve our emotional awareness and resilience, compared to many teams in which no such formal training happens at all
  • We find alternatives to involuntary psychiatric holds in more cases than other mobile crisis teams

Compare Psych Crisis with other services

How is our crisis service more humane than others?

  • Our people are better at listening and de-escalation
  • Our teams have a better balance of skills to respond to more types of crisis
  • We use more and better alternatives to involuntary psychiatric detention
  • We keep in touch with you so we can improve and respond to subsequent problems you’re having

When you reach out for help in a mental health crisis, it’s key if the person who arrives to help you is able to build rapport with you, listen and go beyond surface-level problems, and help you figure out what to do next in a way that makes you feel safe and respected. 

This rarely happens in modern crisis response, because crisis responders are trained to use formulaic assessments rather than authentic conversation, because many first-responders are cops (who have a limited set of approaches in their toolset, some of them dangerous in a mental health crisis), and because being with someone who is in intense or disorganised emotional distress can be confusing and scary for many people, and it takes practice, courage, and a certain type of attitude to be able to respond to calls like these over and over again with patience and compassion. 

At Psych Crisis, we train our first responders to respond authentically, without a script or checklist, to develop their own emotional awareness and resilience, and to become comfortable with the range of mental-health-specific emergencies they should expect to see on the job. 

The default state-mandated training to be a mobile crisis responder: watch ~30 hours of pre-recorded video lectures by mental health academics, telling you what to do and not do when responding to crisis calls. 

Our default training: A minimum of 4 weeks of live training by a crisis responder with 7 years of experience, including instruction on theory and instruction to practice the necessary skills, plus live crisis calls in the field where you apprentice under a more experienced crisis responder, and then acquire the approval of existing colleagues to graduate to a fully responsible crisis responder who can lead your own calls. 

We pair an EMT (Emergency Medical Technician) with a crisis responder (trained like this) to respond to all calls. This is different from the default mobile crisis team, which involves someone with an advanced mental health licence like a social worker or therapist, and a peer worker, neither of whom necessarily have ANY training in handling acute crises. 

Why? In the teams where there is a licensed social worker and a peer worker, neither responder necessarily has the skills necessary to respond well in a crisis situation. They may, but neither the training to be a therapist or social worker, or the default peer worker training, develop any of the specific skills necessary for good, compassionate crisis response. In addition, responding to street mental health crisis calls without the ability to respond effectively to overdoses and other situations where a combination of medical and mental health skill is required limits what kinds of calls the team can respond to. 

In contrast, our combination of EMT and trained crisis worker in a team means the team both have the ability to effectively respond to the specific demands of mental health emergencies, and the ability to respond to overdoses, drug interactions and other situations where the lines between a purely medical problem and a purely psychological problem get blurry. It lets the teams respond to more types of calls and take more of the load away from overstretched police and paramedic teams. 

Lastly, as an organisation, we are committed to minimising the harm that comes from interacting with the emergency response system, and that includes minimising unnecessary involuntary psychiatric detentions and maximising the availability of alternatives to locked inpatient psychiatric hospitals. Data on how often crisis calls end in involuntary commitments is notoriously difficult to find for other services, and so it’s difficult to predict what will happen as you make your own call in a crisis. We commit to publishing how often we use the involuntary commitment process, and how often we use alternatives, in an attempt to model an extremely last-resort-to-stay-alive approach to using what is a legally approved violation of a person’s civil rights.