Module 4: Crisis and Treatment History

4.1 Introduction

Discussing crisis events with applicants can be challenging for a variety of reasons. Some applicants may not remember when or how these events occurred, or applicants may not want to discuss these events because they are too difficult to think about. Screeners may need to consult written records or speak with other people (with the applicant’s permission) to determine the frequency of these items. If no such resources are available (example: the applicant just moved to Wisconsin), complete the screen based on the best information available. In many cases, the applicant might meet eligibility even with incomplete information. The screen can be updated when new information becomes available. If the applicant does not meet eligibility due to insufficient background information, discuss this with the agency screen lead.

General guidelines for answers: frequency and overlapping of events

Most items separate frequency within the past year from frequency 13 months to 3 years ago. This requires screeners to ask two separate frequency questions for each item:

How often in the past year?
How often 13 months to 3 years ago?

If the events have occurred both in the past year and before, indicate the frequency of events in both time periods. Check all that apply or have applied within the specified timeframes.

It might be challenging for some applicants to answer these frequency questions. One event could involve several items in this list. For instance, the applicant might have been suicidal, gotten drunk, assaulted someone, been arrested for operating a vehicle while intoxicated, been injured and treated in the emergency room, and had an emergency detention all in one evening. Alternatively, these all could have occurred as separate incidents. It doesn’t matter. Screeners can check all that apply in each timeframe.

Determining time frames can be important in determining the need for ongoing mental health supports, allows greater recognition of serious problems that occurred more than a year ago, as well as frequent problems in the past year. This recognizes the cyclical nature of mental illness and substance use disorders and stability resulting from mental health and substance use supports recently received.

4.2 Use of emergency room, crisis intervention, or withdrawal management programs

Use of emergency rooms can be for any reason—psychiatric or medical.
The use of an emergency room section does not include going to the emergency room due to an emergency detention, which is included in the Wis. Stat. ch. 51 emergency detention section.
Crisis intervention does not include telephone only contact. Hospital diversion or urgent care visits should be counted as crisis intervention.

4.3 Psychiatric inpatient stays

Psychiatric inpatient stays are defined as any stay in a psychiatric hospital or psychiatric unit of a hospital—voluntary or involuntary.

If the applicant was admitted over one year ago and is still there, check both within the past year and 13 months to 3 years ago.
If that same admission followed a Wis. Stat. ch. 51 emergency detention, check Wis. Stat. ch. 51 emergency detention 13 months to 3 years ago and psychiatric inpatient stay within past year and 13 months to 3 years ago.

4.4 Chapter 51 emergency detentions

Wisconsin Stat. ch. 51 allows for a law enforcement officer or other person authorized to take a person into custody to involuntarily detain an individual if there is cause to believe that the person is mentally ill, drug dependent, or is developmentally disabled. There must be evidence of a substantial probability of harm to self or others (see Wis. Stat. § 51.15).

Check this box for any emergency detention, regardless the outcome of a subsequent court hearing. Actions of the court following an emergency detention are captured elsewhere in the screen. 

4.5 Physical aggression

Physical aggression is defined as causing bodily harm to another person. Torturing or killing animals can be counted here only if it reflects abnormal psychoses, delusions, rage, or punishment of others (such as killing a child’s pet to punish the child). While some people consider raising and killing farm animals to be torture and abuse, screeners should not take this into consideration in this section. If there’s a history of physical aggression outside of the defined timeframes, please note these instances in the notes section.

Verbal aggression is not included here. If verbal aggression is a serious problem, it will show up elsewhere in the screen. Issues with verbal aggression may be captured in the sections focused on housing, social interactions, or managing symptoms.

4.6 Physical aggression has resulted in the injured person being hospitalized

This item collects information on whether the applicant has caused serious bodily harm to another person that has resulted in an admission to a hospital. This does not include emergency room visits that did not end in admission. This question reflects the reality that serious harm to others may have occurred several years ago but it still an important consideration for mental health program eligibility. Check this box if the injured person was hospitalized or was killed.

4.7 Involvement with the corrections system

Involvement with the corrections system is defined as parole/probation, conditional release, bail monitoring, and arrests and/or detentions in a jail or prison. It does not include minor traffic tickets. It does include operating while intoxicated. The involvement is the applicant’s own, not a family member’s involvement. If an applicant is arrested and jailed for the same incident, this count as one event.

Jail/prison is one continuous event and should be captured only when the event was initiated. For example, if a person was jailed 13 months to 3 years and the person was still in jail during the past year, this is one event and should only be captured in the 13 months to 3 years ago time period. This is the case for the corrections question only because being jailed is for a relatively fixed period. It is not reevaluated and extended based on the person’s functioning. If the person was jailed two years ago and released, then jailed again in the past year for a separate crime or a parole/probation violation, both instances should be counted, one occurred 13 months to 3 years ago and one occurred within the past year.

4.8 Suicide attempts

A suicide attempt is an act where the applicant has tried to end their own life. A suicide attempt may or may not need medical attention. If an applicant has identified they have made a suicide attempt within the past 36 months, you should select yes.

All suicide attempts need to be taken seriously. Any details on past or current attempts or ideations should be detailed in the note section.

The second part of this section includes a check box if the applicant has had suicidal ideations with a feasible plan within the past two months. This item is intended to indicate applicants who are currently or recently experiencing suicidal thoughts, a plan and means to carry out suicide, and/or close to suicide (with a plan and means) within the last two months. Do not check this for an applicant who does not have a plan to follow through on suicidal feelings.

If an applicant mentions suicidal thoughts or feelings, be sure to follow your agency’s best practices for risk assessment to ensure their safety.