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. Diagnosis 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 or 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 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
Projects that may be incomplete
Feeling singled out by peers or co-workers; 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 debate the value of living or argue that suicide is right or wrong
Don't ask in a way that indicates you want "No" for an answer, for example:
  "You're not thinking about suicide, are you?"
  "You haven't been throwing up to lose weight, have you?"

Other Things 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