Managing a Mental Health Crisis: A Family Guide

Suicide is not always a potential danger with a mental health crisis, but it can be. You should be aware of the signs that someone is having suicidal thoughts or contemplating suicide, as this requires quick action and emergency medical help:

• A preoccupation with death and talking a lot about death, having no reason to live, feeling trapped, having unbearable pain, or being a burden to other people
• Saying goodbye and giving away possessions, tying up loose ends
• Finding ways to commit suicide, such as getting a gun or a lot of pills
• Significant changes in mood, behaviors, and personality
• Moods that include depression, anxiety, shame, anger, or irritability
• Sudden relief from bad moods, or calmness or lightened mood after being down and despondent for a long time
• Increasing substance use
• Becoming withdrawn from others and from activities
• Sleeping a lot or too little

Anyone with a history of suicide attempts or a family history of suicide is at an increased risk of becoming suicidal. You should especially watch for warning signs in these people.

Suicide is a particular risk of a mental health crisis and needs to be handled carefully. If someone you care about shows warning signs of suicidal thoughts or actions, don’t be afraid to talk about it. Tell this person that you have noticed signs, be straightforward but also compassionate.

Listen to your loved one, offer support, show that you are concerned, and also be reassuring. Never promise to be secretive or to just let it go. Be supportive but firm and avoid making dismissive statements. Don’t try to handle this situation alone. Let your loved one talk to you, but then enlist the help of others.

If your conversation leaves you feeling even more concerned or certain that your loved one is suicidal, call their physician or therapist, or if they don’t have one, call any mental health professional or suicide prevention line. If you know of any dangerous objects that could be used to commit suicide, find them and remove them. This could include any weapons or medications. If necessary, call 911.

In a crisis in which you feel someone may be hurt, either the person experiencing the crisis or others, your first step should always be to call for emergency help. In less severe situations or until help arrives, there are some things you can try to de-escalate the situation. Avoid trying to reason with your loved one or making dismissive or judgmental comments. Instead, try:

• Talking calmly and keeping your emotions in check
• Letting the person in crisis talk and listening to them
• Expressing your concern for them and offering support and help
• Asking how you can help or what you can do for them right now
• Moving slowly and avoiding too much eye contact
• Avoiding anything too stimulating, such as touching your loved one or having music or television playing
• Offering options for what to do next rather than acting as if you are taking control
• Giving your loved one some space
• Announcing what you are going to do before you do it

Essentially, the idea is to remain calm, neutral, and not overbearing. If you are at risk of being harmed, get out of the situation and call for help.

In some situations, you may be able to de-escalate the crisis to the point that you don’t need emergency assistance. In this case, you can call a mental health professional or trusted doctor and make plans for what to do next, such as getting an appointment. If you are concerned the crisis may re-escalate, consider taking your loved one to the hospital for admission. You can also call a local mental health crisis unit to help you decide what to do next.

Calling 911 may be necessary and you should never hesitate to do it if you cannot manage the situation or de-escalate the crisis. Call for emergency help if you have any concerns at all that your loved one may hurt themselves or someone else. When you call, explain the situation in as much detail as possible so that the dispatcher will send first responders trained to work with mental health crises. Describe specific behaviors you are seeing. They need to know what to expect.

If you do have to call 911, be prepared that your loved one may be picked up and transported by police car if an ambulance is not sent. You should also be ready to have your loved one taken to the emergency room, which will likely lead to a long visit. Follow along and bring all the medical information and any medical information for your family member.

Managing a mental health crisis is as much about what you do after as how you handle it in the moment. Anyone who goes through this crisis is at risk for experiencing another, and to minimize that risk they need to get professional treatment on an ongoing basis.

Immediately following the crisis, your loved one may be admitted for stabilization in an emergency psychiatric unit. This treatment typically lasts just two or three days and is designed to help stabilize the patient and hopefully make a plan for the next step. Be aware that while voluntary admission is best, you may be in a position in which you have to involuntarily commit your loved one.

This is better than no treatment at all. You may need a trusted lawyer to help guide you through this process. Otherwise, the admitting physician or even law enforcement may have your loved one committed through an emergency hold, which typically lasts 72 hours.

If your loved one is an adult, request that they sign a document to release authorization of medical information to you. This will allow you to get all the information about their treatment and to be in on making decisions for their care. If your family member refuses initially, keep asking. As they stabilize, they will likely begin to realize they need some support from family.

Once the period of emergency hold or hospitalization is over, you will need to get your loved one into long-term treatment. Residential, inpatient treatment for a few months or longer is ideal. This will give your family member a chance to get dedicated, focused help for learning to manage a severe, chronic mental illness.

Ongoing treatment should include evaluation for all mental illnesses and substance use disorders, various types of therapy, family therapy, group support, psychoeducation, medical care, and plans for aftercare programming.

A crisis cannot always be avoided, especially in someone with a severe mental illness. But there are things that you and your loved one can do to manage that mental illness and reduce the risk or severity of crisis situations.

The most important thing to do is to get good, professional treatment for mental illness. Severe illnesses that are most likely to lead to crises are best treated in a long-term residential program. If possible, take action when you first notice signs that your loved one may have a mental illness. Get a thorough diagnosis and encourage them to get treatment.

Comprehensive treatment in a residential setting can help your loved one in a number of ways: education to better understand their illnesses, therapies to help them learn how to manage symptoms and cope in healthy ways, and medical care when appropriate. Treatment can be effective in managing mental illnesses and reducing the possibility of future crises. With treatment, your loved one can learn to live well with their illnesses and achieve a level of independence if possible.