The Reality behind a Crisis Stabilization Unit
Recently I interviewed my cousin, Talieh Alavi, who works in the mental health field in a crisis stabilization unit. I took the time to ask her a few questions to acquire an in-depth understanding of what it is like to work with mentally ill patients! Down below are my questions and her answers!
Q: What encouraged you to take up a career as a specialist in a crisis stabilization unit?
A: “I got into crisis stabilization by chance. I knew I wanted to be in mental health since junior year of high school when I first took an intro to psych class. After I graduated with my masters degree, I worked in community mental health and addiction for several years, and also briefly tried private practice. Then, I was exploring job opportunities, and got a position at an acute psychiatric hospital for crisis stabilization, and I felt I found my niche. It felt like a perfect fit for my personality, interests, and what I was looking for. I just fell in love with the work and the environment, and I have been doing that ever since.”
Q: What is your speciality in working with mental health patients?
A: In my current position, I am the co-occuring specialist. So I work with patients who, in addition to mental health, also struggle with chemical dependency and addiction. My role is to educate them about addiction and how that may be impacting their lives and mental health, assess their motivation for recovery and sobriety, encourage them to think about recovery, and if they are interested, help connect them with recovery resources out in the community. I also work with them on relapse prevention, and support building. Basically everything addiction and recovery related, as long as they are open to it.
Q: What is it like to treat patients with bipolar disorder or depression?
A: Every patient is different, and symptoms of the same disorder can manifest differently in each patient. Depressed patients, or bipolar patients in a depressive episode are often at a very low point when they come to us. Most patients who come to a psych unit such as ours, get admitted because they are not able to be safe in a less restrictive environment. It takes a lot to get admitted to an acute psych unit. Most depressed patients who get admitted to our unit are either suicidal with a clear plan, intent to act on their plan, and unable to unwilling to contract for safety, or they have just had a serious suicide attempt. Our role is to keep them safe until the imminent danger passes, and they are no longer planning to immediately act on their suicidal thoughts. They may still have some suicidal thoughts by the time they are discharged from us, but they no longer plan to act on them or are willing to reach out for support if the thoughts get worse. For bipolar patients in a manic episode to get admitted to our unit, they have to be so manic that they are disruptive to the community, or dangerous to themselves or others. Sometimes people in a manic episode, if severe enough, can get psychotic and start behavior in dangerous and bizarre ways, they can get delusional, impulsive, or even violent. Again, mania can look different in every person. Our role is to get them stable enough for them to be able to keep themselves safe on their own and continue treatment in an outpatient setting.
Q: What are the most typical behaviors of patients with bipolar disorder or anxiety?
A: I’m not sure if there are any “typical” behaviors of bipolar or anxiety. Symptoms manifest differently in each person, especially anxiety. But as I mentioned, one has to meet very specific criteria to get admitted to an acute psychiatric unit. They have to be either a danger to themselves or others, so suicidal or homicidal, or they have to be so psychotic that they are unable to care for themselves and meet their basic needs. So, in our unit, with anxiety and bipolar depression, you will see a lot suicidal ideation and hopelessness. With anxiety, you might see a lot of pacing around the unit. You also see a lot of psychotic folks roaming about the unit, including manic psychosis. However, all of the mental health disorders out in the community will look very very different and much much less severe. Most people with mental health problems are very high functioning, and their symptoms are well managed. Not all anxiety, depression, and bipolar disorders are so severe and debilitating. So the populations that I work with are not always a fair representation of what the majority of the people with that diagnosis look like. I work with the most severe cases.
Q: How long does it normally take to stabilize a patient when they come to your unit?
A: The average stay in our unit is between 5 to 7 days. We do have some patients who stay a little longer, and some patients who may only stay 1 or 2 days. In some cases, when a patient is very severely mentally ill, they can get court committed, which means they are then court ordered to be in treatment, and their county is in charge of making their treatment decisions. In some of those cases, if the county is not able to find appropriate longer term placement for them (ie. State hospital, which is a longer term psychiatric hospital for the severely mentally ill, or groups homes/foster homes for the mentally ill), the patients can get stuck with us for a long time, sometimes 6-12 months. But those cases are very rare. The length of court commitment in the state of Oregon is 180 days.
Q: What does it mean for the patient to be “stabilized,” in other words, what goals would the patient have to reach before their stay with you ends?
A: For the purposes of our unit, “stabilized” means the patient is no longer an imminent danger to themselves or others, meaning they are no longer planning to immediately harm themselves or another person. If they were severely psychotic, stable would mean they have cleared up enough that they are connected to reality enough that they can now care for themselves and meet their basic needs (ie. feed themselves, bathe themselves, keep themselves safe).
Q: Would you have any advice for the viewers of this website, based on your first-hand experience with mental health disorders?
A: Speak up!! Break the stigma! Mental health is no different than physical health. Just because you can’t see it, doesn’t mean it’s not real! Mental health illnesses are just as real as any physical illness, and there is no shame about it! If you struggle with mental health, it does not mean you are “crazy”. It just means you are struggling with an illness. It is up to each and every one of us to break this stigma, so that those who are really struggling don’t feel shame to reach out for help. If you notice a friend acting “different”, reach out to them. Sometimes, people with mental health disorders really struggle with reaching out for help. Do not let anyone shame you for getting help for mental health. Do not let anyone shame you for taking mental health medication if that is what you need to be well! No one would ever tell you to manage diabetes without meds and with strong “will”. Mental health is no different than physical health! Take care of your mental health just as you take care of your physical health. If you eat well and exercise to keep your body healthy, do things to keep your mind healthy too, whatever that may be! Self care is important!! Self care is not selfish!!
