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Differences after a brain injury may mean that a person may be more likely to experience a "crisis" situation. A crisis is really a subjective experience, varying from person to person, and often relating back to feeling unsafe or not in control. When the individual or others around them are not feeling safe or are threatened in some way, the situation may be able to de-escalate with time, family, and supporters. For others, outside help from law enforcement, emergency response services, or other first responders may be needed to maintain safety.

Behavior After Injury

A person's behavior and actions may be different than they were before a brain injury because the brain's communication is altered or disrupted. Behavior is often a way of expressing oneself, an attempt to adjust to the unfamiliar or changes after brain injury, or frustration to circumstances when verbal expression is difficult. For every display of behavior, there is often a trigger, emotion, or unmet need associated with outward communication. Punishing, ignoring, or giving in to behaviors without identifying the underlying cause may only increase frustration for everyone involved.

Crisis Triggers

Common Triggers

  • Change in routine, schedule, or environment
  • Pain, mood, or sensitivity (ex. light, sound, touch)
  • Social situations & interactions
  • Task frustration or disruption
  • Change in medication, side effects, or missing dosage
  • Irregular sleep or food schedule
  • Desired attention
  • To escape or avoid
  • Anxiety, depression, or other mental health concern

Crisis Examples

  • Threatening statements
  • Self-harm
  • Murderous or suicidal intent
  • Wandering, confusion, and elopement
  • Behavioral outbursts or disruption in the community
  • Abuse or violence
  • Psychiatric symptom expression influenced by mental health concern
  • Substance misuse or overdose risk

Prepare for De-escalation & Crisis

Try to Avoid:

  • Doing nothing or ignoring behaviors
  • Arguing or trying to reason, overreacting, threatening, yelling, or lecturing with the person or their loved ones
  • Crowding the individual or touching the person without permission
  • Fast or abrupt movements
  • Speaking quickly, all at once, or requesting multiple steps at once
  • Using the phrase “calm down”
  • Physically intervening unless for safety

Strive for:

  • Suggesting deep breaths to help calm
  • Keeping your voice calm, clear, and concise Listening and reflecting emotions
  • Expressing support and that you want to help
  • Being patient, allowing for breaks and time for processing as needed
  • Asking how you can help and offering options or suggestions instead of taking control
  • Keeping stimulation low - reduce distractions with one person speaking at a time
  • Announce actions before initiating them

Requiring Outside Intervention:

Escalating situations may include aggression or self-injury becoming recurrent risks, difficulty with containment (elopement or unsupervised wandering), a threat of suicidal or homicidal behaviors, and the individual can no longer be cared for safely in the home. Remain as calm as possible, assess the severity of the situation, and determine who to contact.

  • Dial 211 or your local management entity/managed care organization (LME/MCO) for free, confidential crisis counseling. Visit crisissolutionsnc.org for more options.
  • Dial 911 for life-threatening emergencies.
  • Disclose brain injury to emergency personnel and law enforcement, requesting a Crisis Intervention Team (CIT) trained officer.
  • Visit the website or call the suicide prevention hotline (1-800-273-8255).
A policewoman standing beside her squad car, leaning against it, looking at the camera. She is a mature woman in her 40s. Her partner, an Hispanic man in his 30s, is standing behind her, with his arms crossed.

Crisis Intervention Team (CIT)

The lack of mental health crisis services across the U.S. has resulted in law enforcement officers serving as first responders to most crises. A Crisis Intervention Team (CIT) program is an innovative, community-based approach to improve the outcomes of these encounters. The training is a voluntary, 40-hour training spanning a week for law enforcement, operators, emergency response services (EMS) staff, individuals from the fire department, and other first responders.

According to the National Alliance on Mental Illness (NAMI), not only can CIT programs bring community leaders together, they can also help keep people with mental illness out of jail and in treatment, on the road to recovery. That’s because diversion programs like CIT reduce arrests of people with mental illness while simultaneously increasing the likelihood that individuals will receive mental health services.

  • If this is a medical or a life-threatening emergency, please call 911.
  • If a crisis escalates and you need to contact the police, request a Crisis Intervention Team (CIT) officer. Disclose about diagnoses or any de-escalating strategies that may have worked in the past.

Practice Prevention

  • Give positive feedback more frequently than corrections. Balance focus on essential behaviors vs. being nit-picky.
  • Respect, listen, and validate feelings.
  • Provide clear direction of behavior with appropriate support and expectations.
  • Give choices and set up reinforcement or reward systems when helpful.
  • Allow time, be flexible, and emphasize what you want vs. what you don't.
Multi-ethnic paramedics loading equipment into back of ambulance.  Focus on man on right (40s mixed race, Black and Hispanic).

Resources

Anyone may request crisis or emergency services in North Carolina for mental health, substance abuse, intellectual and developmental disabilities issues. For resources to assist you with a crisis immediately, select your county from the drop-down box on Crisis Solutions NC.

Each Local Management Entity/Managed Care Organization (LME/MCO) has a crisis line and Behavioral Health Urgent Care sites to provide immediate care to adults, adolescents or families in crisis. Mobile Crisis Management services are available for crisis prevention.

If you or someone you know is at risk or contemplating suicide, seek help as soon as possible by contacting a mental health professional or by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or chat at SuicidePreventionLifeline.org. Press 1 for Veterans or military members.

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