Definition of emergency and crisis

An emergency is defined as a situation where a child or adolescent has to be seen immediately or on the same day. The common presentations include suicidal behaviour, extreme violence, psychotic symptoms, acute psychological trauma, and parents who are extremely exhausted and frustrated with the management of the child's behaviour or emotional problem.

Emergency is defined by the nature of the problem as well as by the carers. Adolescents may present as an emergency on their own. The tension is high in an emergency so a prompt response is important.

Emergency should also be understood as a crisis situation. Caplan (!) described the four phases of a crisis situation.

1. There is an initial rise in tension, which calls forth habitual problem-solving responses to restore equilibrium.

2. Next is a failure to resolve the problem with the habitual responses, and a rise in tension and frustration.

3. This stage sees the mobilization of reserves and some attempts at change.

4. Finally, the problem remains unresolved and tension mounts to a dangerous level.

Emergency often occurs at the fourth stage, but it can occur at any one. Clinicians should recognize the tension and frustration associated with the crisis. At the same time, people are more likely to make changes in a crisis. Thus the treatment of emergencies should include containment as well as formulation of a plan for improvement.

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