Chapter 3: Problematic and critical issues

Containing major distress


When families are in acute psychological distress, you can create a protective space that helps them feel safe. Help to ground the person by:

  • Getting a cold washcloth for their face.
  • Speaking in a calm and reassuring way.
  • Sitting on the ground with the person and helping them gradually come back into the sense of their body.

Many individuals freeze or experience intense emotions when traumatized and it will take them some time to unwind from this state of hyperarousal. In almost all cases, the intense emotional moment will pass. Just be patient, present, and offer small words of support and encouragement. Try to get the family member in contact with, and surrounded by, those closest to them as quickly as possible.

When distress warrants professional intervention/referral

“As her husband started to deteriorate, she started coming to the unit intoxicated and threatening suicide. We had to develop a protocol in consultation with Psychiatry for how to respond... This kept her safe as well as the other patients and families”. – ICU Physician

It can be challenging to judge when a family member’s suffering merits a professional referral or intervention. Relying on your team’s collective judgment may be helpful.

Red flags

 The behaviours listed below are red flags that require an immediate response to ensure everyone’s safety. Directly address these with the family so that you can develop and implement a workable plan.  Consider a consult with your psychiatry department in developing a protocol. Situations that might require immediate response and/or referral are:

Scroll over each item for more information.

If a family member displays psychotic features



If a family member displays mania or delusional thinking arrange a psychiatric consult. If you send a family member to psychiatric emergency against their will, this may result in irreparable damage to your relationship.


If a family member reports physical symptoms



Insist they seek immediate medical care.  Some ICUs suggest attending the ER, other ICUs have made links with local family medicine clinics to provide rapid access and assessment for family members.



Highly traumatized family members may have inappropriate and atypical responses, such as rapidly oscillating between crying and laughing. Some may be confused, disoriented, and forgetful. A period of observation may be indicated to determine if the family would benefit from a psychiatric consultation.


How to determine if professional intervention is necessary


Clinician Tip