What to do in a Mental Health Crisis

Key takeaways

• A mental health crisis is when someone’s mental health puts themselves or others at risk of harm.

• A mental health crisis is a medical emergency, and it’s important to reach out for support as quickly as possible.

• Creating a crisis prevention plan can help someone with mental health issues get the right kind of help when things start to go wrong.

Immediate Response Steps - Helping others

If you are currently around someone who is dealing with a mental health crisis, here are some things you might need to do immediately.

Do not leave the person alone

Unless your own physical safety is at risk, stay with the person. A mental health crisis is often a scary experience, and having someone around can be comforting and reassuring. Staying with them also allows you to continue to monitor the situation and ask for additional help if things are getting worse. If you feel unsafe being alone with them, ask someone you trust to come and be with you.

Remain calm and treat them gently

A mental health crisis is difficult to handle, and you can easily feel overwhelmed. Showing your fear or becoming agitated can make it harder for you to help the person who is in crisis, so try to remain calm. Take deep breaths and aim for a calm, gentle voice and slow movements.

Avoid laughing and joking, even if that’s normally part of how you communicate with that person. A mental health crisis can often feel as if the world isn’t entirely real or understandable, which makes jokes, sarcasm, or humor especially difficult. It’s also important not to make them feel trapped. Give them plenty of personal space and try to avoid standing between them and exits where possible.

Assess the risks

Take a moment to consider the risks of your current situation. Is the other person aggressive or attempting to harm themselves? If so, are there any steps you can take to reduce the risk, such as removing sharp objects or medications? What about the environment? If you are outside or in a public place, consider whether there is anything you can reasonably do to make it safer. This could mean trying to move them away from traffic, or asking someone you trust to prevent other people from approaching.

It can be difficult to put your safety first when someone you care about is struggling, but you can only help your loved one if you are also safe. Avoid putting yourself in an unsafe situation, and take whatever steps are necessary to minimize risks.

Reach out for help

A mental health crisis requires the assistance of trained medical professionals. It may also require other services, such as law enforcement. Don’t try to handle the situation by yourself.

If they are in crisis without an immediate risk of harm, contact a mental health provider or doctor who is currently working with them. If they are not currently receiving care, or you do not have the details of their provider, consider other ways to access medical help, such as visiting the emergency room.

If they are suicidal but not actively attempting to harm themselves right now, contact the National Suicide and Crisis Lifeline on 988. You can call or text 24/7.

If there is an imminent risk of harm to themselves or others, contact 911 and explain that you are with someone who is experiencing a mental health crisis. Ask for an officer with Crisis Intervention Team (CIT) training.

Immediate Response Steps - Taking care of yourself

If you are experiencing a mental health crisis, it’s important to seek help as soon as possible. Here are some ways you can take care of yourself.

Don’t wait

Mental health crises require urgent action.^[2] Situations can change rapidly and usually become more difficult to resolve over time, especially if your condition deteriorates enough that you require inpatient treatment in a hospital.^[3] Mental health professionals recognize the importance of raising the alarm as soon as possible, and most would rather be called in to help with a situation too early than to arrive once things have already deteriorated badly.

Check whether you have taken your medication

If you have been given medication to help with a mental health condition, stopping taking it or forgetting to take it can make you feel much worse, and can sometimes lead to a mental health crisis. If you realise that you have missed taking your medication, it can be helpful to take it once you remember to see whether it helps. Do not take more medication than you have been prescribed, and do not take two doses of medication too close together without talking to a doctor first.

Contact someone who can help

A mental health crisis is often a scary experience, and having someone you trust can help you cope.^[4] Contact a friend, family member, or mental health professional to find support and assistance. Having someone physically present can often be helpful, especially if you may need to go to the hospital or take medication. Phone support and assistance can still be helpful if you don’t have anyone local to be there for you.

If you don’t have someone in your life that you trust during a mental health crisis, state and federal helplines offer 24/7 support. The best-known is the 988 helpline, but you may have access to support lines offering specific help for your condition.

Go to somewhere safe

Finding somewhere safe during a mental health crisis helps in two ways. Being somewhere safe reduces the chances of your crisis resulting in actual harm to yourself or another person, especially if you’re able to remove any objects or parts of the environment that pose a high risk. Going somewhere safe can also help reduce how distressing your mental health crisis is, allowing you to remain calmer and making it easier for you to access help.

Find something that helps keep you calm

Staying calm isn’t easy during a mental health crisis, but it can be helpful to try. Look for things, places, or activities that usually calm you. Common suggestions include taking a walk (ideally with someone you trust), petting animals, watching a favorite film, or taking a warm bath. These activities won’t solve your mental health crisis, but they can help you manage the crisis and prevent it from escalating.

Understanding a mental health crisis

A mental health crisis occurs when someone’s mental health is putting themselves or others at risk. This can appear to come out of nowhere, or they can experience slow deterioration of their mental health to a point where they cease to be able to take care of themselves effectively. Examples of a slowly-developing mental health crisis could include severe anxiety that prevents someone from leaving the house to buy food, or someone with bipolar disorder experiencing a manic episode that leads them to take extreme risks.

Contributing factors

Sometimes a mental health crisis has no identifiable cause, but other times it can be the result of a stressful or difficult situation. This can include changes in medication, stressful life events such as changing jobs or moving house, relationship problems, or alcohol or substance use.

Warning signs

Each mental health condition has specific symptoms that may signal a mental health crisis. Some common warning signs are

• Changes in sleeping and eating patterns.

• Dramatic changes in behavior or beliefs.

• Hallucinations, delusions, or a sense of disconnection from reality.

• Thoughts of self-harm or harming others.

• Emotional distress.

• Confusion.

• Lack of awareness of changes in behavior.

• Reduction in self-care, especially hygiene and bathing.

Suicide prevention

One of the biggest dangers of a mental health crisis is suicide. Many people are scared of talking to their loved ones about suicide, but asking about suicide in a non-judgmental way is important for their safety.

Warning signs that someone might be considering taking their own life include

• Giving their possessions away.

• Saying goodbye to loved ones.

• Talking about death and dying.

• Describing a sense of hopelessness.

• Withdrawing from loved ones.

• Stopping usual activities.

• Sudden, unexplained energy after a period of depression.

• Previous suicide attempts or self-harm.

Asking about suicidal thoughts won’t put the idea of suicide into someone’s mind. Studies show that asking openly reduces the risk of someone taking their own life.^[5] If someone does report feeling suicidal, take this extremely seriously. This is a medical emergency, and you should call 911 immediately if there is any imminent risk of suicide.

What to do in a mental health crisis

The goal during a mental health crisis is to remain safe, calm, and comfortable until you can access professional help. In some cases, you may be able to remove some of the underlying causes, which can speed up your recovery.

Staying safe

Take as many measures as possible to keep yourself safe. This includes

• Asking someone to stay with you.

• Removing items that might pose a risk, such as sharp objects or substances.

• Avoid making decisions that might have long-term consequences.

• Finding a place where you feel safe and avoiding people who may not be trustworthy.

Remaining calm and comfortable

The more you can stay calm and try to relax, the easier it is to cope with a mental health crisis. Ideas include

• Distract yourself by watching a favorite film.

• Pet an animal.

• Remind yourself of times you’ve overcome similar feelings.

• Slow your breathing and relax your muscles.

• Make sure that you are warm enough and wearing comfortable clothes.

Removing underlying causes

In some cases, a mental health crisis can be triggered by substance use. If you’re experiencing a mental health crisis, do not attempt to self-medicate with alcohol or recreational drugs. These can make your condition considerably worse and make it harder for mental health professionals to get a clear idea of what’s wrong.

If you have run out of your normal medication and you believe that not taking it may be causing your mental health crisis, you should be able to obtain an emergency refill. You can try contacting your prescriber or the pharmacist. If these are not available, you can bring your prescription bottle to the emergency room for assistance. Even if they can’t provide you with medication, they will be able to ensure that you are safe.

Even if you realise that you have forgotten your medication, it’s usually best to continue to seek help for your mental health crisis. Your doctor may need to know the effect that a missed dose has on your well-being, and you will usually still need support to get back on your feet.

Crisis prevention plans

People with mental health issues can benefit from working with someone close to them to create a crisis prevention or management plan. These should include several sections.

Personal information

Your crisis prevention/management plan should have all the information medical professionals might need in an emergency. This includes

• Your full name, address, and date of birth.

• Your health insurance information.

• Names and contact details of medical professionals you are seeing.

• Your diagnoses and any medications you are taking, including dosage.

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Everyday ways to prevent a crisis

This section of a crisis prevention plan includes the everyday things that help keep your mental health stable. Common items in this list include

• Taking your medication regularly and on time (and ways to ensure you achieve this).

• Staying physically active.

• Getting plenty of sleep.

• Having regular appointments with medical professionals.

• Staying socially active.

Signs that a crisis may be imminent

This section of your crisis prevention plan should give clear signs that you and the people around you can use to identify times when you might be more at risk of a mental health crisis. This includes

• Losing interest in self-care.

• Decreased desire to spend time with others.

• Intrusive thoughts or hallucinations.

• Impaired sleep.

• Changes in behavior.

Try to make these signs as clear as possible. For example, someone with bipolar disorder might say that spending more than a set amount of money in a day is a sign that they might be about to have a manic episode. It can be helpful to speak with mental health professionals, friends, and family, and include early warning signs they’ve observed.

Steps to take at the start of a crisis

This is a key section of a crisis management plan, which explains what people should do if they notice warning signs. Some people find it helpful to be extremely specific, detailing who should be contacted and how quickly, while others prefer a more general approach.

Start with things you can do after noticing some warning signs that might help avoid a crisis. This could be spending time with friends, taking some time off work, or finding ways to reduce stress.

Next, include steps that can be taken once a mental health crisis seems likely. These steps should include

• Who needs to be told, and who is responsible for communicating with them. This might include doctors, psychiatrists, family members, or (rarely) employers.

• What needs to be done to limit the consequences of a mental health crisis. For people with mania, this could include removing bank cards. For those with suicidal ideation, it might be important to have someone else take responsibility for their medication. Someone with anxiety might benefit from having a daily check-in call.

• A list of people or organizations to contact for help and support. Ideally, this includes some support services that are available 24/7.

• If there are people you do not want notified or consulted about your health, you can include this here. You might also want to list any treatments or services that you do not want.

Mental health crises in young people

Young people can be at increased risk for some mental health crises, as illnesses such as schizophrenia usually first appear during adolescence or early adulthood. Children and young people are more reliant on adults and caregivers to get them the support they need.

It’s common for adults to dismiss or overlook mental health issues in adolescents, assuming that it is a normal part of growing up. This can delay getting them appropriate treatment and have long-term consequences. Even if you think of your child’s behavior as a “cry for help”, it’s important to get them that help. Mental health resources for children and young people can usually be accessed via your physician, a social worker, or their school or educational establishment.

Recovering from a mental health crisis

A mental health crisis can take a toll on the people who experience it and those who help them. It’s important to recognize that you’re unlikely to be able to bounce back instantly and resume life as normal.

If you’ve experienced a mental health crisis, give yourself time to recover. You may benefit from a phased return to work if your employer allows this. Prioritize self-care, including eating a healthy diet and getting enough exercise. You may also benefit from spending time with close friends and family and reducing stress where possible. Continue to work with mental health professionals to help your recovery.

If you’ve supported a loved one through their mental health crisis, you may also need to take some time to look after yourself. You may experience uncomfortable emotions about the event, including fear, anger, or shame. These are completely normal, and talking to a therapist, helpline, or mental health professional allows you to discuss and process them.

Further resources

Knowing where to turn is essential in a mental health crisis. Here are some helplines that may be helpful

National Suicide and Crisis Helpline

988

RAINN National Sexual Assault Hotline

(800) 656-4673

Nacional de Prevención del Suicidio (Spanish language)

(888) 628-9454

SAMHSA Substance Abuse and Mental Health Helpline

(800) 662-HELP (4357)

National Eating Disorders Association Helpline

(800) 931-2237

S.A.F.E. Alternatives (Self-Abuse Finally Ends) self-harm helpline

(800) DONT CUT (800-366-8288)

National Runaway Safeline

(800) RUNAWAY (800-786-2929)

Veterans Crisis Line

(800) 273-8255 (Press 1\)

Maternal Mental Health

(833) TLC-MAMA (833-852-6262)