Shetland Lifeline

2.3 The definition we have used and tested with our clients, attempts to express in the simplest way the experience of the person him or herself:

• being overwhelmed by bad feelings such as fear or despair
• losing your usual ability to cope with life
• finding the world very confusing, not sure what is real and what is not real

• people around you becoming very worried and saying you must get help

2.4 Our approach fits in well with Shona Neil’s introductory speech to the SAMH Crisis Conference on 15th June 2005:

“A crisis is not a diagnosis. Nor is it a medical term. For those ‘experts by experience’, people who have used services, ‘crisis’ describes a point they reach where they feel or recognise that things are going awry, and that they need help… This point, in the eyes of a psychiatrist, may not constitute a relapse or acute episode of illness, and if the person seeks help from medical services they may be turned away because they are not ill enough. By the time the conventional services accept that help is needed, the person may no longer want it, may resist it, and may in consequence be compelled to accept treatment.”

3. What are people in crisis asking for?

Our consultation with service users brought to the fore some very clear hopes and preferences for a crisis response service. It may not be practical to meet all these aspirations, but they need to be considered and reconsidered in the light of developments and experience.

3.1 An immediate response to their request for help.

Most of our respondents have experienced several times of crisis. Without help, they do what they can to cope, but can quickly be driven to actions that make their situation worse. It is important to facilitate and not impede or hamper people’s request for help. They are seldom able to plead their case, ‘jump through hoops’ or fill in forms.

When in a state of crisis it is not easy to explain your needs to someone who does not know you and may under or over-react.

Respondents would like a telephone number, available 24/7, as the point of entry to a crisis service. If possible they would like to speak to someone they already know, who can activate a service and not just take details and refer them to someone else.

3.2 And then…?

For some callers, talking on the phone may be sufficient in the short-term; others may need to see someone straight away. They would like a person to be on-call who could set off to see them as quickly as is practical (given the possible distances involved, ferry times, etc). The person in crisis may be at home, or perhaps at the A&E, or a police station… wherever they are, the service may need to come to them, rather than expecting them to come to the service. A visit could be requested by a friend, a neighbour, a family member, anyone in fact, but only with the knowledge and agreement of the person themselves.

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