NCMHR: The eCPR Approach

NYAPRS Note: Thanks to Lauren Spiro, Daniel Fisher, and Leah Harris from the National Coalition for Mental Health Recovery for this timely piece introducing the concept and value behind eCPR, a powerful tool designed to meet the needs of individuals in crisis. NYAPRS hosted an eCPR certification course prior to the 2013 Annual Conference, which many of you completed successfully; we will be sure to alert you to upcoming trainings in eCPR that can teach peers and providers how to better assist community members in emotional crises.


Introduction to the eCPR Approach

eCPR is a public health education program designed to teach people to assist others through emotional crisis through three steps: C = connecting, P = emPowering, and R = revitalizing. eCPR recognizes that the experiences of trauma, emotional crisis, and emotional distress are universal; they can happen to anyone, at anytime, anywhere.


eCPR was developed by over twenty experts with lived experience of crisis and mental health recovery. We know firsthand what helps, and what can potentially exacerbate crisis. One lesson we have learned is that, in general, healing begins in the context of respectful, authentic human relationships. If we project our interpretation onto others' experiences, for example, by starting the interaction with attempting to assess or diagnose them, we may disrupt the connecting process. However, if we focus on listening and believing in individuals’ ability to make it through crisis, we can greatly increase their odds of doing so.


eCPR teaches concrete skills for authentically connecting to persons in crisis through listening to and supporting them in an open-minded, curious, non-judgmental way. Instead of asking "what's wrong with you?" we proceed from the trauma-informed question "what happened to you?" eCPR practitioners also support people to access desired community-based, culturally relevant, trauma-informed, and recovery-oriented resources, so they may move through the crisis and into a meaningful life in their communities.


Breaking the “Revolving Door” Cycle

Conventional treatment for psychiatric crisis or suicidal behavior typically involves a brief inpatient "medication and stablilization" period, usually with little or no attention to the circumstances that caused the initial crisis or distress. A traumatizing and costly revolving door cycle can often ensue, leading to individuals falling into worsening distress.

A recent article by a military veteran seeking help after a suicide attempt illustrates some of the major flaws in the system, as described above. After negative experiences with treatment, people may stop reaching out for help, hiding their suffering from even their friends and loved ones, and retreating into painful isolation. It is this very isolation that fuels emotional distress and crisis. The eCPR approach seeks to break this cycle.

Studies indicate that “the risk of suicide is higher during the period immediately following discharge from in-patient psychiatric care than at any other time in a service user’s life” (Crawford, 2004), due in large part to a lack of social supports upon discharge. Researchers studying poor outcomes for people in developed countries receiving costly treatment for schizophrenia suggest that “something essential to recovery is missing in the social fabric” (Jablensky and Sartorius, 2008). Clearly, our eroded social safety net is a major contributor to individuals’ distress and crisis.

A Health Promotion Approach

Health promotion is defined as “the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions” (World Health Organization).

Our society has evolved to believe that emotional distress and crisis are solely the responsibility of mental health professionals. eCPR was developed with the concept that everyone -- not just mental health professionals -- can and should play a role in helping individuals to achieve wellness and live meaningful lives in the community.


It is our experience that the well-being of individuals is deeply connected to that of the community, and vice-versa. By learning to use the concrete, life-saving skills of eCPR to promote well-being, our communities become stronger and more resilient, preventing crises before they occur. In this way, eCPR is a primary prevention approach, which is considered the most cost-effective form of health care (US Preventative Services Task Force).


It is our hope that if we can build this sense of collective responsibility for one another, we can help many people avoid crisis in the first place, or move through crisis far more quickly and avoid the revolving door cycle. eCPR skills, if applied on a large scale, could go a long way in helping to address our frayed social fabric: the critical missing variable in recovery.


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