Tips for a Mental Health Crisis

When you learn that someone you love has a mental health condition, it can be a frightening time. It's not just the people experiencing episodes of mental illness who need information, it is the people that care for them. The challenge is that information is not always easily accessible, and the search for answers may require more persistence and energy than what we have available, especially in times of crisis.

The potential for a crisis is never far from mind when a mental health condition is present. If you are reading this you or someone you care for may likely be experiencing symptoms of a mental health challenge.

Crisis periods related to mental illness often feel overwhelming. After the initial shock, there is typically a flood of questions.

  • Why me?
  • Why him/her?
  • Why is this happening now?
  • What went wrong?
  • What did we do?
  • What didn't we do?
  • What can we do?

It is normal to feel confused, overwhelmed, or experience guilt, grief, or anger. In these times it is often helpful to remember that we are all doing the best that we can with the resources and information we have available to us.

Like any other health issue, we must address a mental health emergency quickly and effectively.

Because there are often no warning signs, a mental health emergency can be challenging to predict. Even when treatment plans have been followed, and mental health professionals are actively involved, crises can occur.

It is unfortunate, but unpredictability is the nature of mental illness.

Unlike other health crises, people experiencing mental health emergencies often don't receive instructions or materials on what to expect. It is also not unusual for law enforcement personnel instead of medical staff to be the first involved since substance use and behavioral challenges are frequently part of the difficulties associated with mental illness.


Symptoms of mental illness to be aware

Mental illnesses are medical conditions that disrupt a person's thinking, mood, daily functioning, feeling, and ability to relate to others. A person's character or intelligence has nothing to do with their ability to avoid mental illness. We all can understand that diabetes is a disorder of the pancreas. In the same way, mental illness is a disorder of the brain that can make it challenging to cope with the regular demands of life. The person, the family, and their friends are not to blame for mental illness.

Unlike many other health conditions, there are no blood tests that can positively diagnose mental illnesses. Today diagnoses are based on clinical observations of behavior in the person and reports from those close to the person. With a ride range of mental illnesses, symptoms vary significantly from one person to another. The most common mental illness diagnoses include anxiety disorders, bipolar disorder, depressive disorder, and schizophrenia, but there are many others.

Symptoms of mental illness can be similar and can overlap, especially in times of crisis, regardless of the diagnosis. Signs that you may have noticed in yourself or your loved one include:

Withdrawing socially
  • Sitting and doing nothing for extended periods
  • Unusual self-centeredness and self-absorption
  • Losing friends
  • Dropping out of activities that were previously enjoyed
  • Declining performance in academics, work or athletics
Mood Disturbances
  • Deep sadness that is not related to recent events or life circumstances
  • Depression that lasts longer than two weeks
  • Expressions of hopelessness
  • The inability to fall asleep of excessive fatigue
  • Perceiving the world as gray or lifeless (Pessimism)
  • Talking or thinking about suicide
Thought Disturbances
  • Unable to concentrate
  • Unable to cope with minor problems
  • Irrational statements
  • Using peculiar words or language structure in conversation
  • Excessive fears paranoia
Expression of Feelings in an Irregular Manner
  • Hostility (from one who is usually friendly)
  • Indifference to life situations, even those that are considered "highly important"
  • Inability to express happiness
  • Inappropriate laughter
Behavioral Changes
  • Inactivity, hyperactivity, or alternating between the two
  • Bad personal hygiene
  • Rapid weight loss or gain
  • Automobile accidents or poor driving
  • Increased drug and alcohol use
  • Loss of personal possessions and increased forgetfulness
  • Not sleeping for several nights in a row
  • Bizarre behavior
  • Unusual sensitivity to light, noises, or clothing

What Is A Mental Health Crisis

A mental health crisis can be any situation in which a person's behavior puts prevents them from being able to care for themselves or function effectively in the community or puts them at risk of hurting themselves or others. While many things can lead to a mental health crisis, some examples include:

Home or Environmental Triggers
  • Changes in relationship with others (spouse, boyfriend, girlfriend, partner)
  • Death, estrangement or relocation or other losses
  • Arguments or conflicts with loved ones or friends
  • Exposure to violence or trauma
School or Work Triggers
  • Upcoming projects or tasks or projects that may be incomplete
  • Feeling singled out by peers or co-workers/peers; feelings of loneliness
  • Lack of understanding from co-workers, peers, teachers or supervisors
  • Perceived or real discrimination
  • Losing a job or failing grades
Other Triggers
  • Being in large groups of people or crowds
  • Experiencing community violence, natural disasters, terrorism or trauma
  • Pending court dates
  • Using or abusing alcohol or drugs
  • Changing dosage with current medication or starting a new medication
  • Current treatment stops working
  • Missing doses or stopping a medication

Warning Signs of a Mental Health Crisis

When a mental health crisis is developing, it's essential to know that warning signs are not always present. Clues that a mental health crisis is developing include:

  • Inability to perform regular daily tasks like brushing teeth, bathing, brushing hair, changing clothes
  • Increased energy level, rapid mood swings, the inability to stay still; suddenly depressed or withdrawn; suddenly happy or calm
  • Increased agitation including verbal threats, violence, destroys property or "out-of-control behavior"
  • Substance use or self-harm (cutting) or other abusive behavior to self and others
  • Isolation from work, family, friends, school
  • Loses touch with reality - confused, strange ideas, thinks they're someone they're not, doesn't understand what people are saying, hears voices, sees things that aren't there, unable to recognize family or friends,
  • Paranoia

It's important to be aware of how long the changes in personality or daily functioning have been occurring and how much difficulty they're causing. This level of detail can be necessary for the health care professional to know.


When the Crisis Involves the Risk of Suicide

For people with mental health conditions and those who love them, the risk of suicide is a significant concern. Encouraging someone to get help is the first step towards safety.

Feeling overwhelming emotional pain, frustration, loneliness, hopelessness, powerlessness, worthlessness, shame, guilt, rage, or self-hatred is all common in people who attempt suicide. The social isolation that often happens in the lives of those with mental illness can reinforce the belief that no one cares if they live or die.

Any talk of suicide should always be taken seriously. Most people who attempt suicide have given some warning—but this isn't always the case. The risk is even higher if someone has attempted suicide before.


Common warning signs of suicide include
  • Talking as if they're saying goodbye or going away forever
  • Giving away personal possessions
  • Taking steps to tie up loose ends including organizing personal papers or paying off debts
  • Stockpiling pills
  • Obtaining a weapon
  • Making or changing a will
  • Sudden cheerfulness or calm after a period of sadness
  • Preoccupation with death
  • Increased drug or alcohol use
  • Dramatic changes in personality, mood and/or behavior
  • Withdrawal from friends, family, and regular activities
  • Saying things like "Nothing matters anymore," "You'll be better off without me," or "Life isn't worth living"
  • Sense of utter hopelessness and helplessness
  • Failed romantic relationship
  • History of family/friend suicide or attempts
  • History of suicide attempts or other self-harming behaviors

What To Do If You Suspect Someone is Thinking About Suicide

If you are concerned someone is thinking about suicide or if you notice any of the above warning signs, don't be afraid to talk to them about it. You can start the conversation.

Open the conversation by sharing specific things you have noticed, including: "I've noticed lately that you [aren't interested in sports anymore, which you used to love, haven't been sleeping, and are posting a lot of sad song lyrics online, etc.] …"

Then say something like:
  • "Are you thinking about suicide?"
  • "When was the last time you thought about suicide?"
  • "Do you have a plan? Do you know how you would do it?"

If the answer is "Yes," or if you think they might be at risk of suicide, you need to seek help immediately.
  • Call a therapist or psychiatrist/physician or other health care professional who has been working with the person
  • Remove potential means such as weapons and medications to reduce risk
  • Call the National Suicide Prevention Line at 1-800-273-8255 or call 911

Listen, express concern, reassure. Focus on being understanding, caring, and nonjudgmental, saying something like:
  • "I may not be able to understand exactly how you feel, but I care about you and want to help"
  • "You are not alone. I'm here for you"
  • "You are important to me; we will get through this together"
  • "I'm concerned about you, and I want you to know there is help available to get you through this"

What Not to do
  • Don't try to handle the situation alone
  • Don't promise secrecy. Say instead: "I care about you too much to keep this kind of secret. You need help, and I'm here to help you get it."
  • Don't ask in a way that indicates you want "No" for an answer • "You're not thinking about suicide, are you?" • "You haven't been throwing up to lose weight, have you?"
  • Don't debate the value of living or argue that suicide is right or wrong

What Not to say
  • "It's all in your head. Just snap out of it."
  • "We all go through tough times like these. You'll be fine."

Please remember, a suicide threat or attempt is a medical emergency requiring professional help as quickly as possible.


Techniques that May Help De-escalate a Mental Health Crisis
  • Avoid overreacting
  • Keep your voice calm
  • Express support and concern
  • Listen to the person
  • Ask how you can help
  • Avoid continuous eye contact
  • Move slowly
  • Avoid touching the person unless you ask permission
  • Be patient
  • Keep stimulation level low
  • Offer options instead of trying to take control
  • Gently announce actions before initiating them
  • Give them space, don't make them feel trapped
  • Don't argue or try to reason with the person
  • Don't make judgmental comments

To read the entire document from the National Alliance on Mental Illness, visit: https://www.nami.org/About-NAMI/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis/Navigating-A-Mental-Health-Crisis.pdf