One of our residents of the shelter recently showed up having a panic attack.
This was no “ordinary” panic attack.
The panic attack was so bad that the gentleman was hallucinating that people were setting him on fire.
I had to look this up. It’s real.
See, for example, Galynker, et. al., Panic Attacks with Psychotic Features, J Clin Psychiatry. 1996 Sep;57(9):402-6.
The man appeared to be in absolute anguish, alternating between pleading for help and disconnecting from reality while screaming in agony.
It looked terrifying for him.
It was also scary for everyone nearby.
Complicating the situation, I had never met the man; I had no idea of how he reacted to these situations…
…and he had his keys in his hand. Not exactly a weapon, but dangerous none-the-less.
The next twenty minutes I tried to use the basics of de-escalation for an entirely new situation:
- I had back-up staff nearby. I motioned for them to call the paramedics, so I didn’t have to.
- I kept my nonverbal communication calm, quiet and slow.
- I kept an appropriate distance, especially when a wave of hallucinations would come over him.
- I kept an eye on his car keys until I could get him to put them in his pocket.
I also had to improvise:
- I repeated over and over that he was safe.
- I repeated over and over that we would not leave him alone.
In the end, the paramedics arrived and were able to pull him completely out of his panic attack.
I had a lovely talk with the man afterwards.
This happened a few weeks ago, and I’m still processing it for lessons on how to handle similar situations in the future.
Learning to “de-escalate” is a lifelong process
I have worked in a large homeless shelter most of my adult life.
I assumed that I had seen just about everything possible related to mental health, substance use, trauma and de-escalation.
I—obviously—was wrong.
There is ALWAYS something new to learn.
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Someone from my team will be in touch.
Have a great week!
Peace,
Ryan