Crisis Intervention

Crisis intervention is a brief preventive assessment and psychotherapy administered following a personal or group crisis.

The term crisis intervention can refer to several different therapeutic approaches applied in a variety of critical situations affecting either individuals or groups of people. The common denominator among these interventions, however, is their brief duration and their focus on improving the stability of a person (or group of people) undergoing an acute reaction to a stressor rather than on treating longstanding mental disorders. Some common examples of crisis intervention include suicide prevention telephone hotlines, hospital-based crisis intervention, and community-based mental health services mobilized during a disaster.

Underlying most models of crisis intervention is what has been termed the trilogy (threefold) model of crisis. According to this model, a crisis has three parts or aspects: 1) a precipitating event; 2) intense distress on the part of a person involved in the event; and 3) a breakdown of the person's usual coping methods, causing the person to function at a lower level than before the event and have difficulty dealing with the stressor. On this basis, one can see that a crisis includes a subjective dimension (the person's reaction of distress and temporary loss of the ability to cope) as well as an objective dimension (the precipitating event).

It is the subjective element that is the focus of crisis intervention: The counselor seeks to help the distressed person change his or her perception of the stressor and to regain his or her ability to function. Thus, crisis intervention has an educational as well as a healing function; in many cases, the person in crisis benefits from learning better coping strategies as well as having his or her immediate physical and emotional needs met.



This primary source contains information from a fact sheet from the World Health Organization (WHO) on the topic of diabetes, a noncommunicable disease that has emerged as a major cause of death globally. Along with key facts, the sheet describes consequences, prevention, diagnosis, and treatment.

In some parts of the world it is only during or after an emergency that people with mental health disorders get any treatment at all and often the help on offer is not what they need, Dr Mustafa Elmasri tells Fiona Fleck that the international community needs to rethink its emergency mental health relief.

Q: Much of your work has been in the Middle East and northern Africa, what kind of mental health care is provided in these countries?

A: It differs from country to country. Often they have very few psychiatrists. Much of the mental health care response is dependent on external initiatives and funding. This leads to mistakes.

Q: Is this typical?

A: It happens after each disaster. You have a rush of interested donors, but usually these projects and interventions are short-term and, therefore, counterproductive.

Q: Are the locals also unhappy about this?

A: People in need are usually happy to receive assistance, but in some cases it is not effective and quite inappropriate.

Q: What is your approach?

A: I work with the local experts and structures regardless of their knowledge and expertise.

Q: Does cultural background playa role?

A: Every mental health intervention should be adapted to the culture, today this is a given.

Q: Describe your work and your life in Gaza?

A: We are integrating mental healthcare into the primary health care structure. The target is the wider population people who would not normally approach the mental health services.

>Q: Can you give examples of this work?

A: Our approach is to develop the capacity of mental health workers within the existing mental health and primary care services to provide competent and continuous help.

Q: It's against IASC (Inter-Agency Standing Committee) guidelines, why do we continue to see psychotherapists parachuting into emergency situations?

A: I encountered this phenomenon in Cambodia. I found it was better to train social workers in counselling and behavioural techniques of psychotherapy.

Q: What was your experience in Cambodia?

A: There were psychiatrists and psychologists from different parts of the world communicating through interpreters. International specialists should not provide direct clinical care of local people but should work with and support local care providers.

Q: What about countries with little or no mental health experts?

A: Development is a natural phenomenon that you can assist or hinder, not something you plant or create. I worked with Darfur refugees in Chad. It had one psychiatrist for the whole population. I trained traditional healers, local nurses and medical assistants. My first year involved establishing a clinical service for people with severe mental illness and children with epilepsy.

Q: How did you do this?

A: I collaborated with the faqihs (experts on Islamic law) from both the refugee and local Chadian communities, who treated medical and psychological illness. I trained them to identify epilepsy and psychosis. We also shared experiences on how we dealt with stress and mild mental illness, and learned from each other.

SOURCE: “Mental health beyond the crises.” Bulletin of the World Health Organization vol. 89. No. 5. World Health Organization, May 2011, p. 326–327. (accessed September 21, 2015).

Types of crisis intervention

Crisis hotlines

Crisis or suicide hotlines offer immediate support to individuals in acute distress. Since they are usually anonymous, individuals in difficulty may find themselves less embarrassed than in face-to-face interaction. Most hotlines are staffed by volunteers supervised by mental health professionals. Suicidal callers are provided with information about how to access mental health resources in the community and are encouraged to seek them and to feel hope. Further, some centers will arrange referrals to clinicians. Typically, crisis hotlines do not offer therapy directly. If a volunteer feels a caller is at immediate risk, however, confidentiality will be suspended and a mental health worker will be called to intervene.

Although crisis hotlines are numerous, whether they effectively reduce suicide has not clearly been demonstrated. Some researchers fear that the people who call may not be those at highest risk. For many centers a small fraction of callers appear to represent a large fraction (estimated up to 50%) of the total phone contacts. A further problem is that there appears to be significant discrepancies in the training of telephone operators at these hotlines.

Community-based crisis intervention

Hospital-based crisis intervention usually refers to the treatment of people with psychiatric emergencies that typically arise during a crisis. The aim of this type of crisis intervention is usually the stabilization of some type of extreme behavior. Professionals regard patients who are suicidal, homicidal, extremely violent, or suffering from severe adverse drug reactions or psychotic disorders as major psychiatric emergencies. In the United States, when individuals appear to represent imminent danger to themselves or others, they may be admitted to hospital inpatient treatment against their will for a brief period (e.g., 72 hours). In Canada, one may be involuntarily committed and never receive treatment. When treatment is administered, however, it is usually in the form of psychotropic drugs with follow-up outpatient therapy scheduled upon release.

Critical incident stress debriefing

A relatively recent type of crisis intervention involves the mobilization of mental health professionals following transportation disasters, school shootings, natural disasters, and other mass casualty events. The professionals who arrive on the scene attempt to administer preventive procedures to avert such mental disorders as depression or post-traumatic stress disorder. The best-known of these is psychological debriefing, or CISD (critical incident stress debriefing), which originated in the military. CISD is a one-session group intervention conducted 1–3 days after a traumatic event. As originally designed, it has seven parts: an introduction; the facts of the event; immediate thoughts and impressions; processing of emotional reactions; normalization; planning for the future; and re-entry to previous routines.


Critical incident stress debriefing (CISD)—
A form of one-session group crisis intervention used after major traumatic events.
Trilogy model of crisis—
The model of crisis used in crisis intervention training, according to which a crisis has three aspects or dimensions: a precipitating event; subjective distress on the part of a person involved in or affected by the crisis; and the person's regression to a lower level of functioning.

Some investigations of CISD suggest that counselors should be more cautious about its use. Some observers maintain that having people focus on the upsetting event emphasizes the victimization that has already taken place, rather than people's innate abilities to overcome these challenges. In other words, CISD may make people feel worse by making them question their own coping abilities. Some studies of the use of CISD in schools following school shootings suggest that CISD may be more effective for adults than for adolescents or children. These studies serve as reminders that a particular psychological intervention may require further research and modification if necessary.

Models of crisis intervention

There are two commonly used models of crisis intervention used in training counselors to work with individuals in crisis. The first is the Roberts seven-step model, first presented by Alvin Roberts in 1991; the second is the so-called SAFER-R model, developed by George Everly Jr., in 2001. Both models outline the basic steps and the proper sequence involved in the process of crisis intervention.

Roberts’ seven-step model

The Roberts model is intended for effective brief treatment of a person in crisis:

The SAFER-R model

This model uses the initial letters of its six steps to assist memorization:

See also Coping; Posttraumatic stress disorder; Stress; Suicide.



Kanel, Kristi. A Guide to Crisis Intervention, 5th ed. Stam ford, CT: Cengage Learning, 2015.

Lindemann, Erich. Beyond Grief: Crisis Intervention. Northvale, NJ: Jason Aronson, 1995.


Archbold, T. “The Psychiatric Assistance Line. One Solution to the Child and Adolescent Mental Health Crisis.” Minnesota Medicine 98 (March 2015): 42–44.

Boscarino, J. A. “Community Disasters, Psychological Trauma, and Crisis Intervention.” International Journal of Emergency Mental Health 17 (January 2015): 369–71.

Gould, S., et al. “Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: Evaluation of Caller Risk Profiles and Interventions Implemented.” Suicide and Life-threatening Behavior, August 4, 2015 [E-publication ahead of print].

Pfefferbaum, B., et al. “Child Debriefing: A Review of the Evidence Base.” Prehospital and Disaster Medicine 30 (June 2015): 306–15.


Providentia. “The Cocoanut Grove Fire.” (accessed August 16, 2015).


American Academy of Experts in Traumatic Stress (AAETS), 203 Deer Rd., Ronkonkoma, NY, 11779, (631) 543-2217, Fax: (631) 543-6977,, .

American Foundation for Suicide Prevention (AFSP), 120 Wall St., 29th Fl., New York, NY, United States, 10005, (212) 363-3500, (888) 333-AFSP, Fax: (212) 3636237,, .