Crisis Management (Acute Psychotic Episode)
Planning For A Crisis Or Emergency
• Make sure that clear mechanisms are in place for obtaining timely specialist help in an
emergency (a strategy that is agreed with secondary care services and written down in a crisis
management plan).
- Identify day and night contact numbers for psychiatrist, social services,
crisis team, ambulance and police.
- Consider whether any re-assessment should take place in home,
A&E Dept or hospital ward.
- Ensure main carers know exactly who to contact in any crisis/emergency situation.

Acute Situation
• Assess the risk of self-harm or violence before seeing the patient
- Check medical records of any previous episodes.
- Discuss the situation fully with carers and other relevant professionals.

• Ensure that physical help is available if needed (e.g. other professionals/Police).
• Avoid being left alone when assessing the patient, with no quick exit route.
• Assess whether the patient’s mental state has changed or not/identify and risk to self or others.
• Consider drug treatment if the patient is consenting.
• Consider requesting CMHT assessment (if Mon-Fri 9-5/Pt NOT known to CMHT -
request DANS assessment).
• Consider the need for informal admission. If compulsory admission is indicated:
- If patient is known CMHT, contact appropriate CMHT psychiatrists team.
- If patient is not known to the CMHT, or it is outside of normal working hours,
contact the duty specialists register/consultant psychiatrist in the first instance -
involvement of an approved social worker usually comes later when a consultant
has confirmed availability of a bed for compulsory admission.

* Review the crisis and identify and record any lessons to be learned for future crisis management.

Giving Information And Advice To Patients & Carers
Information should be given on: symptoms, treatment (including effects & side-effects of drugs),
prognosis, who to contact for which problems and when, benefits, housing, employment, contact
details for voluntary organisations e.g. MIND, National Schizophrenia Fellowship and SANE.
It is important that patients and their main carers are advised what to do in the event of a
crisis or emergency.

Useful Recommended Literature
National Institute for Clinical Excellence ‘Information for patients on (atypical) antipsychotic drug treatment for schizophrenia’. See www.nice.org.uk

Useful Websites For Users & Carers Info
www.nhsdirect.nhs.uk
www.schizophrenia.com
www.rethink.org
www.psychiatry24x7.com

Support Organisations & Their Helplines
MIND Info line 08457 660 163
Rethink (Nat.Schiz Fellowship) 020 8974 6814
SANE Telephone SANELINE on 0845 767 8000
Making Space 01925 571680

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