Ever wonder what goes on behind the doors of a suicide hotline? A psychiatric crisis service performs many of the functions of a suicide hotline and more. Different agencies work in different ways and in different venues. I am going to tell you about my experiences as a psychiatric crisis worker and while doing that give you a glimpse into the workings of the psychiatric crisis center I've worked in for the past 15 years. Not all centers work the same way. Different laws apply in different states, and services often also depend on the amount of funding the agency receives. Mine is located in the northeast, and receives funding, from state agencies, grants and from insurance company payments.

Here's a good brief overview of crisis intervention theory: CI Theory

The job consists of a lot of phone work as very often this is our first contact with a client. They get our phone number from the phone book, the telephone operator, their therapist or another agency. For example, the local homeless shelters and food pantries have given our number out. We get calls from the Department of Children and Families, The Department of Mental Health, and other state agencies whose consumers have gone into crisis.

We also get clients who walk into our office; they have heard about it from a friend or an agency, and desperation drives them to our door.

Finally, my agency does what we call mobile assessments - we go to where the client is. That may be a hospital emergency room or a doctor's office or even a client's home, if we can determine that the clinician going there would be safe. Occasionally the situation escalates and we call the police.

Where I work we work with psychiatrists who have the ability to commit people to a psychiatric facility; they work with us to apprehend people who are deemed to be a danger to themselves or others.

Once we have determined the type of help someone needs, we find or help find a setting in which they can receive the treatment. There are various levels of treatment that range from being in a locked psychiatric hospital unti to seeing a therapist on what we call an outpatient basis. There are programs where people can go daily and short term programs designed to get someone back on their feet.

Another service we perform is getting a promise from insurance companies that they will pay for the service rendered for the client. For example, if a client is sent to a hospital, we get an assurance from the insurance company that they will pay for the stay, then we pass that information on to the hospital.

My agency has an additional service that they call a crisis stabilization unit. This is a place within our facility where we can treat clients who need brief residential services but not all the bells and whistles of a hospital. This allows the client to recover in a less formal setting and without the stigma that sometimes is associated with an admission to a hospital psychiatric unit.

This is a general idea of what we do. In future articles I will go into more details and tell you something about the types of clients we see, what their diagnoses are, and how an interview is conducted. I will also talk about some of the more interesting clients I have seen and some of the interesting things that happen in the office - as you can guess, in such a high stress job, we have developed unique ways of relaxing and dealing with it.