Responding to a drug induced mental health crisis

Techniques to establish safety and trust:

• Speak slowly and confidently with a gentle, calm tone of voice
• Give your name and explain your role and purpose if you do not know the person
• Use non-threatening body language
• Avoid touching, shouting or sudden movement
• Stay calm and provide any necessary support slowly and gently

Offer clear and supportive communication:

• Use clear language
• Explain any actions you need to take beforehand
• Avoid intense questioning
• Ask how you can best help the person right now
• Paraphrase their concerns
• Do not challenge psychotic thinking or collude in delusions
• Do not argue or threaten
• Where someone is presenting as mentally confused avoid sarcasm, laughing or humour that may be misunderstood
• Comply with reasonable requests e.g. making a phone call

Establish physical safety:

• Think about environment. Is there somewhere quieter or where a person might feel more comfortable? Be aware of risk management when staying in or changing an environment
• Reduce unhelpful distractions/audiences (ask others to leave)
• Consider if having a friend (s) to stay with someone is helpful/unhelpful
• Avoid restricting the person’s movement unless unsafe

Verbal reassurance and support:

Talking through or down, depending on an individual’s drug experience and levels of agitation. It may be more appropriate to simply empathetically listen to concerns and offer reassurance where required. Where someone is very agitated or less experienced, they may prefer to be talked down where you are more directive in your support. Some useful strategies for this are:

• Normalising their experience e.g. “cocaine can cause some people to feel anxious or paranoid, you are safe here and the effects will start to wear off soon”
• Distraction and re-focusing techniques e.g. engaging in a conversation about something else or asking them to focus on something in the room
• Grounding techniques e.g. deep belly breathing, counting (an example techniques is described below)

Five things grounding technique:

• Notice five things that you can see. Look around you and bring your attention to five things that you can see. Pick something that you do not normally notice, like a shadow or a small crack in the concrete.
• Notice four things that you can feel. Bring awareness to four things that you are currently feeling, like the texture of your trousers, the feeling of the breeze on your skin, or the smooth surface of a table you are resting your hands on.
• Notice three things you can hear. Take a moment to listen, and note three things that you hear in the background. This can be the chirp of a bird, the hum of the refrigerator, or the faint sounds of traffic from a nearby road.
• Notice two things you can smell. Bring your awareness to smells that you usually filter out, whether they are pleasant or unpleasant. Perhaps the breeze is carrying a scent of trees if you are outside, or the smell of a fast food restaurant across the street.
• Notice one thing you can taste. Focus on one thing that you can taste right now, in this moment. You can take a sip of a drink, chew a piece of chewing gum, eat something, or think of something you like the taste of.

Once a level of safety has been established and de-escalation strategies have helped the acute phase of the crisis to pass, it is important to look at what other supports might be beneficial. The person may benefit from support to develop self-management techniques should future crises occur.

It is common for people, particularly where they have underlying mental health issues, to experience repeated crises. These experiences can provide insights into resources and coping skills that have been effective or have yet to be tried. Discussions can help formulate action plans and form self-management techniques.

Some people may require more specialist help as part of follow-up. This may include referral to community mental health or psychological therapies teams (see Treatment section).

The acute effects of cocaine can include a sense of inflated confidence, sexual arousal, reduced need for sleep, reduced appetite and increased agitation and paranoia. Taking cocaine when already feeling anxious can heighten the sense of anxiety. Deprived sleep can exacerbate existing mental health difficulties as well as cause new mental health problems.