Crisis and Suicide

Recent alcohol binges.

Supportive family engagement.

Insomnia for the past month.

Loud, pressured speech and pacing.

History of intermittent explosive disorder.

Mild

Moderate

Severe

Panic

Speak in a calm voice and validate feelings while maintaining safe distance.

Obtain a restraint order and prepare four-point restraints.

Confront the threatening statements and demand immediate cooperation.

Ask the family to enter and help calm Alex.

Stand directly in front of the exit to ensure control.

Request group therapy to process anger immediately.

Increase lighting and invite unit visitors for distraction.

Move to a quieter room with reduced stimuli and provide short, simple directions.

Ignore the behavior to avoid reinforcing attention-seeking.

Ensure safety by removing hazards and calling additional trained staff for assistance.

Begin lengthy education on stress physiology to improve insight.

Threaten to call law enforcement to ensure compliance.

Patient refusal to take scheduled medication.

Imminent danger to self or others after lesser measures fail.

Family request to control behavior.

Short staffing on the unit.

“No one cares if I live or die.”

“I cannot sleep lately.”

“I skipped classes this week.”

“I am angry with my family.”

Offer PRN oral anxiolytic if prescribed.

Use seclusion first to prevent stimuli exposure.

Employ guided breathing and grounding cues.

Attempt mechanical restraints prior to verbal techniques.

Engage a trained staff member to continue verbal de‑escalation.

Offer ordered oral PRN anxiolytic after verbal techniques fail and agitation persists.

Begin with IM sedatives before attempting verbal strategies.

Use PRN solely to enforce staff control.

Administer PRN without consent because admission was involuntary.