A crisis is not the size of the event. It is the gap between what has happened and what the person can currently cope with, which is why two people can lose the same job and only one of them stops eating. Work five arrivals: name the type, place the person on Caplan's four phases, then choose the first thing you would actually say. Every option opens with its reasoning, and the console on the right keeps the crisis-intervention sequence and the psychological first aid rules in view.
Five arrivals
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The sequence you will actually use at a bedside
Crisis intervention is deliberately narrow. The goal is the person’s pre-crisis level of functioning or better — not insight, not personality change. Open each step.
Directiveness is calibrated to functioning. The more disorganised the person, the more structure you provide — short sentences, one instruction at a time, concrete choices. As they reorganise, you hand decisions back. Handing decisions back is not a courtesy; it is the therapeutic mechanism. Someone who leaves a crisis contact having made two of their own decisions has evidence that they are still an agent in their own life, which is exactly what the crisis called into question.
Your console
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Arrivals worked
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Types named
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Phases placed
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First moves therapeutic
Phase 1 familiar coping, anxiety rises modestly · Phase 2 familiar coping fails, trial and error · Phase 3 emergency resources mobilised — novel problem-solving, asking for help, redefining the problem · Phase 4 major disorganisation: profound anxiety, sleep and concentration gone, behaviour that alarms others. Answer a phase question and the console marks the phase.
The four-to-six week window is the entire clinical opportunity. Left alone, acute disequilibrium resolves one way or the other within weeks — upward, with new coping and a higher baseline, or downward into a lower level of functioning, a new diagnosis, or death. What you do in those weeks disproportionately decides which.
Psychological first aid: what it is and what it deliberately is not
Does
Physical safety and basic needs first — water, warmth, a charger, a toilet, a place to sit
Calm, non-intrusive comfort; presence without pressure
Connection to social supports and to family by name
Accurate information, repeated, in short sentences
Practical linkage to services with a named person and a time
Does not
Push a person to recount the traumatic event in detail
Run a mandatory single-session emotional debriefing — trials show it does not prevent post-traumatic stress disorder and may worsen outcomes for some
Rank one survivor’s loss against another’s
Substitute a leaflet for a follow-up contact
Presence, practical help and connection are the evidence-based intervention. Forced narration is not.
Trauma-informed care is the default posture
Assume a trauma history may be present in every person you meet on a behavioural unit, because the base rate is high and the history is often not in the record. This is not a therapy; it is a way of running a service so that care does not re-injure.
SafetyTrustworthiness and transparencyPeer supportCollaboration and mutualityEmpowerment, voice and choiceCultural, historical and gender issues
On the floor it sounds like this. Tell people what is going to happen before it happens. Explain why a search or a blood draw is being done. Knock. Use the person’s preferred name. Offer genuine choices wherever a choice exists, and never use power casually. Ask “what happened to you?” rather than “what is wrong with you?”, and record what the behaviour communicates rather than a judgement about the person’s character.
Read behaviour through that lens. A person who becomes intensely distressed when a staff member stands between them and the door is not being unreasonable. A person who freezes and cannot answer a direct question is not refusing to cooperate. Being held down by several people, having clothing removed, being confined to a locked room or being watched while using a toilet reproduce the conditions of prior abuse with uncanny precision — which is why every restraint is treated as a treatment failure worth examining.