Mental health level 2 warning

Refers to an individual experiencing moderate emotional and behavioral abnormalities that last for more than 2 weeks, has not yet reached clinical diagnostic standards for mental illness, has clear real-life triggers, and has caused mild to moderate damage to daily social functions. The core treatment principle is "early intervention without generalization, appropriate coordination among relevant parties, and avoid risk upgrade to level 1 (severe) early warning."

Last year, I came across a typical case when I was doing on-site intervention at a university psychological center: Xiaonan, a sophomore girl, did not go to advanced mathematics classes for three weeks in a row. Her roommate reported that she lay in bed every day and checked her mobile phone until three or four in the morning. She would not get up during the day. After the squad leader reported the situation, we made a preliminary assessment: he had no thoughts of suicide or self-harm, and he could still eat and wash normally. The trigger was that the senior officer whom he had a crush on for half a year announced his relationship, and he was ostracized for confessing his love in public in high school. This incident triggered previous negative memories, and was finally rated as a Level 2 warning.

Don’t mention it, there are actually quite big differences among practitioners in different directions in terms of the evaluation standards for Level 2 warnings. Doctors with psychiatry background pay more attention to hard indicators: Do symptoms last for more than 2 weeks? Do you have any psychotic symptoms such as hallucinations and delusions? To what extent are social functions impaired—can you go to school and work normally? Can you maintain basic personal hygiene? As long as it does not reach the level of clinical diagnosis and does affect normal life, it can basically be determined. However, psychodynamic counselors will pay more attention to "whether the degree of reaction matches the trigger." For example, if someone loses a relationship and feels sad for a week, but you feel sad for a month and still can't get over it, is it related to the attachment trauma in your early years? Counselors who engage in CBT (cognitive behavioral therapy) will first look for cognitive biases: whether "he doesn't like me" has been extended to "no one will love me in this life." This distortion of core beliefs is the point that needs priority intervention. At present, there is no unified evaluation standard answer in the industry, and most of them are based on a combination of multiple dimensions.

The biggest misunderstanding that many people have about the Level 2 warning is that they either regard it as a scourge, or they don’t take it seriously at all. I have been in contact with the HR of an Internet company before. The department reported that a male employee's performance was not up to standard for one month in a row. He sat in a daze at his desk every day and did not speak in meetings. The HR directly judged him as having a "bad attitude" and dismissed him. Later, I found out that his mother had just been diagnosed with advanced gastric cancer. He did not dare to say anything for fear of affecting his work. He endured it for almost two months. On the day he was fired, he collapsed downstairs in the company and was sent to the hospital for a diagnosis of severe depression. What was originally a second-level warning risk suddenly became a first-level warning that required hospitalization. Some schools treat students with Level 2 warning as if they are facing a threat and take them home directly to their parents, not even allowing them to take final exams. Originally, the children were just stressed out and in a bad mood, but being treated so specially made them feel that they were "abnormal", which in turn increased the psychological burden.

I have been doing psychological crisis intervention for almost 6 years. When I encounter a Level 2 warning situation, I usually don’t set up a high-profile “help group”. Instead, I form a small group of three people at most: a person close to me who the client trusts most (roommate, colleague, or close friend), a professional counselor to connect with, and me. When something happens, we synchronize in the group. There is no need to hold discussion meetings at every turn. It is too easy to put the pressure on the client that “I am a patient who needs special care.” Oh, by the way, there is another issue that has been controversial in this industry for a long time: Should family members be notified as soon as possible during the Level 2 alert? Those who support believe that safety is the bottom line, and guardians have the right to know, and no one will be held responsible if something goes wrong; those who oppose feel that if the person involved is extremely repulsive to his family members, such as a high school student who was forced to commit suicide by his parents before, and has just been adjusted to the second-level alert status, if the parents are notified rashly, it may directly intensify the conflict and lead to bigger things. The current common practice in the industry is to conduct a risk assessment first. As long as there is no clear risk of self-injury or suicide, the consent of the person concerned will be obtained before contacting the family. Exceptions will be made only in special circumstances.

In fact, speaking of it, the Level 2 alert is like a cold with a 38-degree fever: if you say it’s serious, it’s not to the point where you need to be hospitalized for pneumonia, and you might be able to get better if you carry it yourself; if you say it’s not serious, if you stay up late and mess around, you may develop myocarditis and leave sequelae. The best state is to drink more hot water and rest more. People around you don't have to chase you every day and ask "Are you feeling better?". Handing you a cup of hot milk and asking if you want to go downstairs for a walk are more effective than saying "Don't think too much" ten times.

After doing this for a long time, I feel more and more that the most important test of level two warnings is never any advanced professional skills, but a sense of proportion. You can't treat the other person like a glass doll that breaks at the touch of a touch and don't let him do anything; nor can you just say "What's the big deal" and ask him to get better quickly. After all, there is no unified timetable for overcoming the hurdles in everyone's heart. It’s already good if you can do it without disturbing, not being dismissive, and being moderately supportive.