Crisis

The clinician in crisis intervention prescribes acute pharmacotherapy for agitation, makes involuntary treatment decisions, implements system-level violence prevention programs, and manages complex medico-legal aspects of crisis care. Prescribing for acute agitation requires rapid assessment of the most likely etiology: psychotic agitation (antipsychotic-based regimen), anxiety/panic agitation (benzodiazepine-based), substance intoxication (depends on substance: benzodiazepine for stimulant-induced agitation, antipsychotic for PCP/hallucinogen-induced, naloxone for opioid), alcohol/benzodiazepine withdrawal (benzodiazepine), and undifferentiated agitation (combination approach or ketamine for severe cases). The clinician understands involuntary treatment criteria (varies by jurisdiction but generally requires: danger to self, danger to others, or gravely disabled/unable to care for basic needs) and implements these with respect for patient autonomy and least-restrictive alternatives. The clinician also leads system-level interventions: implementing Safewards model (environmental and interpersonal interventions to reduce conflict and containment), reducing restraint and seclusion use, trauma-informed crisis response, and staff training in de-escalation. The clinician prescribes and manages PRN medication protocols for psychiatric units, ensuring safe and evidence-based options are available for nursing staff to administer.