Supporting Individuals Experiencing a Psychiatric Emergency
At Cornerstone, we specialize in assisting our members in navigating a wide range of challenges that can arise during travel. When those challenges encompass issues related to mental health and medical needs, these can significantly impact an individual's ability to travel or return home, especially in cases involving a psychotic break.
Experiencing a mental health crisis abroad can place participants in incredibly vulnerable situations. Over the past year, our Mental Health team has provided guidance to Headquarters and program staff supporting participants experiencing acute symptoms that impacted their ability to safely complete itinerary and programmatic guidance. In today’s article, we guide you through a case study of support provided to one such organization, to demonstrate the value of having expert mental health support just a phone call away.
Setting the Scene
Being stranded halfway across the globe and grappling with overwhelming stressors, an individual on a travel program found themselves in a sudden state of mental distress and unable to manage their journey back home. Recognizing the urgency of the situation, the individual was admitted to psychiatric care in the Asian host country. Understandably, the family was deeply distressed by the circumstances, having never encountered such a situation before and seeking guidance and assistance. The member reached out to Cornerstone, relying on our expertise in risk management, medical care, and mental health support to help navigate this complex situation.
Cornerstone’s First Steps
The primary objective was to facilitate the traveler's safe return to their home country, particularly given the potential risks associated with receiving psychiatric care abroad, where treatment approaches may differ significantly and where concerns about patient release and care may arise.
However, ensuring a safe return home proved to be a challenging endeavor, particularly concerning the individual's fitness to fly amidst a psychiatric episode.
Here's how the situation unfolded:
Cornerstone was alerted to the emergency through the organization's On-Call thread, prompting immediate action from all three branches of our team.
Our medical professionals conducted an assessment of the individual's medication regimen and what they’d be prescribed in the host country, collaborating closely with our mental health experts to evaluate their efficacy, potential side effects, and suitability based on the individual's medical and psychiatric history.
The Cornerstone Mental Health team worked with the organization to help them identify what was happening, given the symptoms and observed behavior of the individual. They were able to identify ways the field staff could manage the situation in real time without involving psychiatric care in-country (which would have prevented the individual from returning home and created legal challenges).
Meanwhile, our risk management team provided essential guidance to the family, outlining the steps required to comply with fit-to-fly regulations and offering support in coordinating return preparations while prioritizing the individual's long-term well-being.
Throughout the ordeal, we maintained regular communication with the member and traveler's family, ensuring ongoing support and monitoring as they awaited further developments and worked toward achieving stability to meet fit-to-fly criteria.
Following this initial phase, our focus shifted to guiding the family through the process of attaining fit-to-fly status and facilitating their safe return home, where the individual could receive continued care from medical professionals.
How this Case Study may Apply to your Organization
As part of our commitment to supporting individuals in similar situations, our mental health team developed a set of tips and guidance to assist those navigating similar challenges, ensuring a smoother and more informed journey toward recovery and well-being:
Transportation Safety Tips for Flying (Medicated)
Make sure the patient is sufficiently hydrated throughout the trip - especially if prescribed medications (like Haloperidol and Fluephenazine).
Avoid substances or alcohol.
Be mindful of side effects of medication, such as dizziness. Take it slow when transitioning from sitting to standing on each mode of transport and get up to move during long stretches of sitting.
Long flights will disrupt sleep cycles, so be mindful that this can increase psychiatric symptoms and try to get sleep where possible.
Decreasing the Risk of Over-Stimulation before Travel
Prepare for travel-related stressors: Being in new environments or around different people may increase stress levels, potentially exacerbating symptoms. Identify potential stressors such as flight cancellations or gate changes, and openly discuss them with the individual to provide support.
Communication strategies: Use open-ended questions to inquire about any concerns or worries regarding travel. Examples include, "Is there anything that’s worried you in the past about traveling?" or "Is there anything worrying you about this trip?"
Plan ahead: Rehearse responses to potential stressors as a family. Having a plan in place can help manage unexpected delays or changes effectively.
Encourage proactive communication: Encourage the individual to express feelings of stress or discomfort promptly. Consider implementing a color system for check-ins (e.g., green for feeling good, yellow for feeling stressed but manageable, red for needing immediate assistance).
Establish a communication code: Develop a word or phrase to quickly communicate discomfort or the need for support to the rest of the family. For instance, use a code like "James" to signal the need for a check-in or support, such as "[Name], remind me to check-in with Dr. James about the upcoming appointment."
De-escalating Situations during Travel
Communicating updates: Provide reassurance and updates about the boarding process, such as "We're waiting to board; we should be able to board in the next 30 minutes."
Review itinerary: Utilize rehearsal time to go over the itinerary with the individual and address any concerns they may have.
Recognizing signs of distress: Stay vigilant for common signs of agitation or stress, including pacing, finger/toe tapping, rapid talking, or restlessness.
Sensory considerations: Be mindful that individuals experiencing psychosis may misinterpret sensory stimuli such as sound, touch, or light. Offer orientation and consider using soothing sounds like music to help navigate difficult travel moments.
Mitigation strategies: Offer support and distractions as a first step. If symptoms persist or worsen, consider backup plans, such as obtaining additional medications from the hospital, using distraction techniques, or potentially postponing further travel.
Safety considerations: Offer support and medication early on. If it feels unsafe to board or continue the trip, discuss alternative options with each other. Consider backup plans for connections, including potential accommodations, nearby emergency rooms, etc.