From Crisis to Compassion: Transforming Inpatient Psychiatric Care
By Imaan Siddiqui UA‘23 and Jim Stellar
First, some author background: This blog post was primarily written by IS with input from JS. It belongs in this blog series, which started in 2009 with a focus on experiential education in college and the cognitive planning (neocortex) and emotional reaction (limbic system) that goes into decisions about an ultimate career path starting with the college major. Indeed, this is how we two met – first in the classroom as a student and professor at the University at Albany and then as a mentee and mentor. We worked together a bit then and now have come to this blog after IS not only worked for a few years in the field (as a Mental Health Assistant at EllisHospital, NY, and previously as a foster care caseworker) but has now entered an online master’s degree program in social work at Columbia University. If you read the more recent blog posts, you will see that the topic of clinical issues and even broad societal issues have been viewed through the lens of cognitive-emotional integration.
From Crisis to Compassion
Inpatient psychiatric settings can be challenging for both patients and staff. This blog emphasizes the critical need for de-escalation training, burnout prevention, and trauma-informed care to create safer, more compassionate environments. De-escalation training equips staff with tools to manage crises calmly, reducing restraints and building trust. Addressing burnout ensures staff well-being, which enhances care quality and workplace stability. Trauma-informed care shifts the focus to understanding patients’ experiences, fostering empathy, and empowering their recovery. By investing in training, staff support, and patient-centered approaches, these settings can become spaces of healing and hope.
The Critical Need for De-escalation Training in Inpatient Psychiatric Settings
Imagine walking into a room where the air feels heavy with tension. Patients in crisis, staff juggling multiple responsibilities, and emotions running high. For many working in inpatient psychiatric settings, this isn’t just a rare moment—it’s a daily reality. These settings are designed to heal but sometimes feel overwhelming without the right tools and support. De-escalation training, addressing burnout, and understanding trauma can transform these environments into safer, more compassionate spaces for everyone involved.
Why De-escalation Training Matters
Picture this: A patient becomes agitated, their voice rising, fists clenched. As a staff member, your heart races. How do you respond? De-escalation training provides the answer. It’s not just about calming the moment; it’s about building trust and ensuring safety for the patient and yourself.
De-escalation training provides the skills to:
- Use active listening to understand the patient’s perspective while being able to offer an alternative view.
- Communicate in non-verbal ways that signal calm and empathy.
- Use language tailored explicitly for emotionally charged situations.
Without this training, situations can spiral quickly, leading to physical restraints or seclusion—traumatic experiences for patients and emotionally taxing for staff. But with the right skills, these moments can become opportunities for connection and healing.
The Hidden Toll of Burnout
Let’s be honest: Working in inpatient psychiatric settings is tough. Long hours, emotionally charged situations, and sometimes feeling like there’s never enough support; it’s exhausting. If you’re a staff member reading this, you might be nodding along—maybe even feeling that exhaustion yourself.
Burnout affects more than just you; it also affects the care you can provide. Patients sense when staff are stretched thin, which can erode the trust needed for effective treatment. The ripple effect is real. When one staff member leaves due to burnout, the workload increases for everyone else, perpetuating the cycle.
But here’s the good news: You’re not alone. There are ways to combat burnout. Organizations can step up by providing mental health resources, offering regular breaks, and ensuring staffing levels that support the team. As individuals, we can remind ourselves to pause, breathe, and ask for help when we need it.
When was the last time you truly prioritized your own well-being? How might a small change—like taking a moment to breathe—shift your day?
Trauma-Informed Care: Seeing the Whole Person
Now, let’s shift gears. Many patients in psychiatric settings carry invisible scars from past trauma. They may react strongly to situations that remind them of those experiences—sometimes in ways that seem irrational at first glance. Trauma-informed care is about seeing the whole person, not just their behaviors.
For example, if a patient lashes out verbally, trauma-informed care encourages staff to ask, “What happened to this person?” rather than “What’s wrong with them?” This shift in perspective fosters empathy and helps staff respond in supportive rather than punitive ways.
Next time someone reacts unexpectedly, pause and ask yourself, “What might they be feeling or remembering right now?” See how your perspective on the situation changes.
The most important aspect of trauma-informed care is empowering the patient. This can take many forms, from involving them in their treatment plans to something as simple as letting them pick which blanket to use. It may seem minor to us, but to patients who have had their voices stripped away in so many situations, it could be the action that earns us their trust.
When patients feel heard and respected, they’re more likely to trust the process and engage in their own recovery.
Connecting the Dots: De-escalation, Burnout, and Trauma-Informed Care
These three areas—de-escalation, burnout, and trauma-informed care—aren’t separate issues. They’re deeply connected. When staff are trained in de-escalation techniques, they feel more confident and less stressed. When organizations prioritize staff well-being, burnout decreases, creating a more stable and supportive environment. When trauma-informed care becomes the foundation of treatment, patients and staff experience less tension and more meaningful interactions.
Here’s an example: you’re working with a patient who starts shouting. Instead of reacting defensively, you use your de-escalation skills to stay calm. You’ve also had training in trauma-informed care, so you recognize that their shouting might be linked to a past experience. By addressing the situation with empathy and patience, you not only de-escalate the moment but also build trust for future interactions. And because your workplace supports your mental health, you feel equipped to handle the emotional toll of the situation. It’s a win-win for everyone.
Let’s Make It Happen: What We Can Do
Transforming psychiatric settings starts with action. Here’s how we can move forward:
1. Commit to Training:
- Leadership needs to prioritize de-escalation and trauma-informed care training for all staff. Make it regular and comprehensive.
- Create opportunities for staff to practice these skills in realistic scenarios.
2. Support Staff Well-being:
- Provide mental health resources, peer support programs, and regular check-ins.
- Ensure manageable workloads by addressing staffing shortages.
3. Listen and Learn:
- Collect feedback from staff and patients to identify areas for improvement.
- Use data to measure the impact of training and support initiatives.
4. Design Healing Spaces:
- Create calm and safe environments with areas for patients to decompress.
- Foster a culture where staff feel valued and heard.
Your Role in the Bigger Picture
Whether you’re a healthcare worker, a leader in your organization, or someone passionate about mental health, you have a role to play in creating change. By advocating for de-escalation training, supporting staff well-being, and championing trauma-informed care, you can help transform psychiatric settings into places of hope and recovery.
The challenges in inpatient psychiatric settings are immense, but so are the opportunities for growth and healing. By investing in people—both patients and staff—we can create environments where everyone feels safer, stronger, and more supported. Let’s commit to making that vision a reality, one step at a time.
Closing note for the blog series: We recommend you go back to the blog and look at some recently posted longer blogs about trauma, societal instantiation of trauma, and even cross-border migration under difficult circumstances, as well as a variety of recent clinical-leaning posts on ADHD and even how cognitive-emotional integration may work in the frontal part of the neocortex. We think all of this forms a pattern of how decisions are made whether we are talking about the famous recent book by Daniel Khaneman (Thinking fast and Slow) or the writings of a 1600’s philosopher and mathematician, Blaise Pascal, whose phrase we take as foundational in human nature and guides our blog thinking, “The heart has reasons that reason does not know.”
