Crisis intervention is one of the essential aspects of social work, in which practitioners have to be aware of practice strategies and how to implement them. In the interview reported case under consideration, the interviewee came into contact with the case of an individual who had been diagnosed with mental health and developmental issues and suicidal tendencies. The individual ended up starting a fire and walking onto the path of an oncoming truck on the highway in spite of having been assigned 24 hr supervision. Through the case, the concept of crisis management is explored, complete with recommendations regarding how such cases can be handled in the future. The paper also recognizes the role of mental health issues on criminal behavior, specifically fire-setting by teenagers. Through the case under consideration, it is established that mental health issues such as depression and pyromania can push teenagers towards negative criminal behaviors, and handling crises involving such issues would need caution to ensure the underlying issues are addressed.
Crisis Intervention Report and Recommendations
The involvement of individuals in criminal activities is commonly associated with various factors, particularly issues related to mental health. Understanding the underlying motivations of criminal activity can help in establishing approaches that not only address the resulting crime but also reduce the probability of future recidivism after corrective measures. To get insight into some of the drivers of criminal activities, an interview was conducted with Tonya Southers, a targeted case manager and Quality Assurance supervisor at Adair County SB40 Disability Services. Tonya has worked for her organization since 2010 and clearly understands the nature of crises that are commonly experienced in relation to child services. During the interview, she confirmed that at different times in her career, she has had to deal with multiple scenarios in which individuals, mainly juveniles, engaged in various dangerous activities as a result of mental illness. These incidences, in most cases, resulted in crises that required effective strategies to manage without harm to any of the involved individuals.
Part 1: Interview Summary
The objective of the interview was to obtain information regarding one such incidence. The incidence narrated by Southers involved a teenage male living in one of the facilities that provide Integrated Service for Looked-after Children (ISL). The boy had been previously observed to display suicidal tendencies. Two days before the reported crisis, the boy had been heard asking what the staff at the ISL would do in case he jumped into the pond. He had also tried to step onto the road in the path of an oncoming truck and had to be pushed off the road by a staff. Thereafter, he was placed on a 1:1 supervision model to be under the watch of the facility supervisors at all times during the day and night. All resources that could be used to aid suicide were removed from his room, and he was left with only a mattress and a blanket. During his sleep time at night or otherwise, a member of the staff would be posted outside his door with instructions to give a 15-minute interval bed check. During waking hours, the boy had to be always within sight of a staff member. The situation that arose, therefore, came as a surprise to all the employees at the facility as the first question that was asked was how he managed to bypass the visibility of the supervisor assigned to him at the time of the crisis.
On the day of the crisis, Southers was already on her way home when she passed by the ISL, which was on the way to her home. At the ISL, there were fire trucks and several police cars. She decided to stop by and go into the ISL instead of going straight home and waiting to be updated by a call. At the ISL, she found out that the boy had burned his apartment. From all indications, it would be considered as a case of arson. Additionally, he had walked into the highway again, although there was no indication of hurt. The most pressing questions in the case included where he had gotten the source of ignition and how he had managed to ignite his apartment with the supervision that was supposed to be with him 24 hours a day. The boy, however, insisted that he had not started the fire but did not feel remorseful to anyone.
Considering this case, Southers had to solve a multifaceted crisis in that the individual in question could not be left at the facility as he had already set his apartment ablaze. The juvenile office would not take him in due to his mental and developmental issues. Similarly, the fact that he had committed arson meant that no hospital would take him in either. Moreover, there was a need to find out various facts about the case. For instance, what made the boy step onto the road on that day, where was the supervisor at the time of the incident, what would be the best course of action since there is a need to take immediate action, and where would the boy stay given his current condition? These questions portray a crisis that can be handled only through the effective use of various crisis management tools and techniques.
For Southers to have been able to solve the crisis, it would be necessary to collect data from various people at the ISL. For instance, the administration would need to give information on who was supervising the boy on the day of the incident. The supervisor would be required to give a report pertaining to where he/she was at the time of the incident and what would have happened for the boy to ignite his apartment. This information would, however, have been insufficient to determine where to take the boy for safety or how to handle the rest of the concerns pertaining to the crisis. The most important question that needed to be answered was whether the boy could continue living in a restrictive environment given his mental and developmental status and the suicidal tendencies he had repeatedly exhibited. It is observable that the boy probably needs help. However, the first help he needs is to help curb the developmental and mental issues he is facing. This would subsequently have a positive effect on suicidal tendencies. Additionally, Southers needed to find out where to get help for the boy. The help would not have been easy to come by, given the already escalated situation, and would require the consideration of several opportunities. Thus, Southers needed to be very cautious about the next course of action in attempting to assist the boy.
Part 2: Crisis Intervention Strategies
The crisis intervention process begins with the determination of the issues requiring immediate intervention and outlining measures that are to be taken to ensure that those issues are addressed. From the case description, the interviewee effectively handled this first step of crisis management, clearly stating the facts of the case and outlining the issues under contention. However, it is not possible to determine whether the actions of the interviewee following the establishment of the issues under contention were satisfactory for the resolution of those particular issues. First, it is evident that Southers used facilitative listening to collect all the necessary information. The principle behind facilitative listening is to allow everyone to present their opinions. In the use of facilitative listening, it was established that Southers collected information from the victim. However, there are no indications that information was collected from the other individuals involved in the case. In using facilitative listening, the interviewee would have used verbal encouragement to initiate communication from the other parties. Giving verbal affirmations that one is listening is considered as one of the strategies for facilitative listening (Caspersz & Stasinska, 2015). This strategy could be used with individuals such as the boy in this case or even the supervisor who was supposed to be working with the boy during the incident.
At the time of the crisis, the arson and suicide attempts by the teenager are both considered criminal activities that warrant punishment via legal procedures. However, various studies have shown that, in most cases, criminal activities among juveniles are motivated by mental health issues. According to Burton, McNiel, and Binder (2012), criminal tendencies such as arson and fire setting are most commonly observable in individuals with mental health issues, particularly pyromania. Blum, Odlaug, and Grant (2018) described pyromania based on the diagnostic procedure given in DSM V, in which the condition is defined as the characteristic deliberate and repetitive fire-setting. This fire-setting tendency is unrelated to any probable outward rewards and cannot be explained based on any other diagnosis such as drug abuse, which could be linked to similar behaviors in other scenarios. This means that for the management of crisis cases in which the perpetrator is a teenager who feels no remorse in his activities, there is the possibility of pyromania that should be explored further. Lindberg et al. (2005) suggest that pyromania can only be diagnosed if the fire-setting symptom is not accompanied by any other symptoms that point to the presence of other mental health issues. Additionally, Schwartzman, Stambaugh, and Kimball (1998) purport that the prevalence of fire-setting has increased over the years, particularly among teenagers. These fires can be either accidental (whereby they are set by children when playing) or intentional (whereby they were set deliberately by children and teenagers). Handling such cases would require an understanding of the exact reasons behind the behavior.
The second issue in the case was the tendency towards suicide. The teenager in question had attempted to commit suicide by walking onto the road previously and had even thought about jumping into the pool. Previous studies show that suicidal tendencies are common among teenagers with mental health issues. According to Ludi et al. (2012), the risk factors for suicide among youths include alcohol and drug use disorders, mental health disorders such as depression and bipolar disorder, feelings of distress, agitation, and/or irritability. Suicide results in adverse socio-economic and psychosocial effects and efforts should be made to identify any suicidal tendencies in others (Bilsen, 2018). The Suicide Prevention Resource Center (2012) reported that suicide among youths is commonly associated with biopsychosocial and sociocultural issues. Addressing suicidal tendencies, therefore, requires approaches that help to address the underlying mental health issues.
Dealing with mental health issues such as pyromania and suicidal thoughts can be challenging, especially where there is no clear diagnosis. According to Ford and Moseley (1963), point out that while there are definite approaches that can be used to address various types of mental health issues, there are no standard or appropriate measures for dealing with suicidal behaviors. Various studies, however, report that cognitive-behavioral therapy is effective in the treatment of various mental health issues, including depression and bipolar disorder (Thase, Kingdon, & Turkington, 2014). Similarly, Blum et al. (2018) described the applicability of cognitive-behavioral therapy in the treatment of pyromania. This implies that for the individual, in this case, supposing the suicidal thoughts and the fire-setting were the results of a combination of pyromania and another mental illness, cognitive behavioral therapy would be effective in realizing the treatment.
Selecting the intervention of choice for this patient would have involved consideration of the various factors surrounding the case. From the literature explored, the crisis intervention techniques that would be most suited to the case would begin with awareness creation. Awareness creation, in this context, would entail speaking to the boy to find out his feelings after the incident and probably what he felt before. The other techniques would include emphasizing a focus on the intended objective and providing guidance and protection to the affected individual. Identifying social work professionals suited to the task would be the start of the guidance and protection procedure. If the specific mental condition of the patient had been diagnosed prior to the incident, he could have started the cognitive behavioral therapy treatment before the period of 1:1 supervision as he had been diagnosed with mental health issues earlier than that. As such, there could have already been some progress towards healing.
A crisis of a magnitude similar to what occurred could be addressed by first finding a safe place for the involved individual. The safe place, in this case, could be with a different child services institution, where he could find repose for a while as he needs somewhere to stay. Following that placement, he would be booked into counseling sessions with a counselor that has prior experience working with individuals suffering from pyromania and depression or other forms of mental health conditions. Identifying such counselors would be easy from the county databases that Southers should have access to. For individuals who are at risk of facing similar crises, understanding the symptoms of the mental health underlying certain behaviors can help to plan for treatment before the symptoms escalate. Improving the situational response would require prior preparation for crisis management beyond setting supervisors to be on the lookout for negative behaviors.
While the strategies for addressing these conditions have been highlighted in previous research, the relationship between pyromania and other mental health conditions has not been explored. Similarly, the neurobiology of pyromania is still a subject that requires further study. It is, therefore, recommended that the preparation process for effective treatment should include in-depth consideration of the characteristics of various mental health conditions to eliminate all others before settling on pyromania as the underlying condition driving the negative behaviors in the client
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