What a year in the psych emergency room taught me about handling crisis.

Photo of Los Angeles County Firefighter at the Eaton Fire, January 10, 2025 by CAL_FIRE_Official

In 2011, as part of my first-year placement as a social work student, I spent time in a psychiatric facility.

Field placements are part of everyone’s social work training and at UCLA, by design, they place first-year students in a placement that is the exact opposite of their desired focus of study.

From the beginning, I knew I wasn’t interested in clinical social work. My interest was in program development, research, and policy analysis. So, naturally, UCLA assigned me to the psychiatric emergency facilities at a county hospital conducting solution-focused and group therapy for individuals experiencing mental health crises.

It was far outside my comfort zone - and one of the most formative experiences of my life. That first year in social work training provided some of the best lessons in crisis response techniques.

In the wake of the recent Los Angeles fires and the weeks of unfettered attacks on our governmental systems, many of us are in crisis.

By definition, a crisis is a change in human or environmental affairs that happens abruptly and overwhelms our traditional coping mechanisms.

Sound familiar?

The past few months have been rough and ugly. Hard, emotional, scary, frustrating. While that is all true, we still have to find a way forward.

So now what?

As I search for a way ahead, I find myself relying on the evidence-based crisis response practices I first learned during that initial-year placement. I believe some practices serve as a useful blueprint for the broader scope of any nonprofit crisis response.

Here are the steps I find most applicable:

Step 1: Address the presenting emergency.  The individual presenting with a psychiatric emergency had to first be moderately stabilized so they were deemed no longer an immediate danger to themselves or others. The emergency had to be attended to first. In other words, the priority in any crisis is to address the immediate emergency - stop the immediate harm, put out the fire, stop the data breach, stop the financial bleeding – before formulating a response plan.

Step 2: Diagnose the crisis. Once the individual was stabilized, doctors would take measures to diagnose the specific mental health crisis. Determining whether it was schizophrenia or bipolar depression also determined appropriate treatment. Identifying what type of crisis has occurred and who is most impacted will likely help an agency determine the most appropriate response. If, for instance, the crisis is a natural disaster, a certain amount of logistical response will be required. If the crisis is a financial loss, then financial experts may need to be consulted. Your response will depend on the type of crisis and the people directly impacted.

Step 3: Conduct a thorough needs assessment.  Diagnosis and assessment would happen in quick succession. Social workers would typically conduct an assessment to identify the physical, mental, and social strengths and weaknesses of the individual to help define any realistic treatment plan. Doing a needs assessment of your agency and community will help you determine the most pressing needs and potential avenues of strength and support.

Step 4: Bring a multidisciplinary team together. All psychiatric response plans were developed by a multidisciplinary team - including a psychiatrist, a social worker, and a case manager - each bringing their unique expertise to formulate a holistic treatment approach. This ensured consideration of the individual's physical, mental, social, and logistical needs. Similarly, the most effective crisis response plans are shaped by a diverse team with varied perspectives on the organization. This team could include the board president, senior leadership, key directors, and even possibly, an external expert to provide an objective viewpoint.

Step 5: Create a short-term action plan to address the top three presenting needs. A psychiatric hold was brief, so the priority was stabilizing the individual quickly and setting them up for long-term stability. With your multidisciplinary team, focus on immediate next steps - what your agency will do this week, the next week, next month, and in three months. This is not the time for long-term planning or solving every issue, but for addressing the most urgent needs.

Step 6: Be strength-based in approach. A strength-based approach leverages an individual’s existing strengths to drive outcomes. For example, if an individual had a strong social support system, their crisis response plan would actively incorporate that network. Similarly, nonprofits may want to consider strengths they have while developing their response plan. For nonprofits, strengths often lie in reputation and community partnerships. A well-established reputation could help foster trust and position your organization as a credible leader during a crisis. Tapping into your community partnerships may help bridge any gaps in executing your response plan. Leaning into your strengths will likely maximize your agency’s ability to respond.

Step 7: Stay flexible.  Treatment plans were regularly reassessed, discussed and modified based on the presenting needs of each day. Once a plan had been determined it was treated as a working road map. The expectation was that it would change.  Nonprofit crisis response planning may benefit from following the same flexible approach—regularly reassessing and adjusting strategies based on evolving information. In a crisis, things change rapidly. Thus, plans should be treated with the expectation that they may need to adapt as new information and needs emerge.

These are the basic steps the psychiatric team took to manage individuals in active crisis. When adapted to nonprofits, they provide a useful framework for navigating some of the circumstances in which we currently find ourselves.

The goal is stabilization, not permanent solutions.

Just as psychiatric facilities prioritized rapid assessment, flexible planning, and leveraging strengths to address urgent needs, nonprofits can apply these same principles in times of crisis. By staying adaptable, relying on existing resources, and focusing on short-term actions that lead to longer-term stability, organizations may be able to effectively manage crises while laying the groundwork for future recovery.

No one wants to be in crisis. But at times, unfortunately, that is what we are asked to face.