This article is excerpted from the publication Navigating a Mental Health Crisis | A NAMI resource guide for those experiencing a mental health emergency. To obtain a free copy of the full guide, click here.

Understanding a Mental Health Crisis

A mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community. Many things can lead to a mental health crisis. Some examples of situations that can lead or contribute to a crisis include:

Home or Environmental Stressors

  • Changes in relationship with others (boyfriend, girlfriend, partner, spouse)
  • Losses of any kind due to death, estrangement or relocation
  • Conflicts or arguments with loved ones or friends
  • Trauma or exposure to violence

School or Work Stressors

  • Worrying about upcoming projects or tasks
  • Feeling singled out by co-workers/peers; feeling lonely
  • Lack of understanding from peers, co-workers, teachers or supervisors
  • Real or perceived discrimination
  • Failing grades, losing a job

Other Stressors

  • Being in crowds or large groups of people
  • Experiencing community violence, trauma, natural disasters, terrorism
  • Pending court dates
  • Using or abusing drugs or alcohol
  • Starting new medication or new dosage of current medication
  • Treatment stops working
  • Stopping medication or missing doses

Warning Signs of a Mental Health Crisis

It’s important to know that warning signs are not always present when a mental health crisis is developing. Common actions that may be a clue that a mental health crisis is developing:

  • Inability to perform daily tasks like bathing, brushing teeth, brushing hair, changing clothes
  • Rapid mood swings, increased energy level, inability to stay still, pacing; suddenly depressed, withdrawn; suddenly happy or calm after period of depression
  • Increased agitation verbal threats, violent, out- of-control behavior, destroys property
  • Abusive behavior to self and others, including substance use or self-harm (cutting)
  • Isolation from school, work, family, friends
  • Loses touch with reality (psychosis) – unable to recognize family or friends, 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
  • 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 important for the health care professional to know.

What to Do in a Mental Health Crisis

When a mental health crisis occurs, friends and family are often caught off-guard, unprepared and unsure of what to do. The behaviors of a person experiencing a crisis can be unpredictable and can change dramatically without warning.

If you’re worried that you or your loved one is in crisis or nearing a crisis, seek help. Make sure to assess the immediacy of the situation to help determine where to start or who to call.

  • Is the person in danger of hurting themselves, others or property?
  • Do you need emergency assistance?
  • Do you have time to start with a phone call for guidance and support from a mental health professional?

A person experiencing a mental health crisis can’t always clearly communicate their thoughts, feelings, needs or emotions. They may also find it difficult to understand what others are saying. It’s important to empathize and connect with the person’s feelings, stay calm and try to de-escalate the crisis. If the following suggestions don’t help, seek outside assistance and resources.

Techniques that May Help De-escalate a Crisis:

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

If you can’t de-escalate the crisis yourself, you can seek additional help from mental health professionals who can assess the situation and determine the level of crisis intervention required. If you don’t believe there is an immediate danger, call a psychiatrist, clinic nurse, therapist, case manager or family physician that is familiar with the person’s history. This professional can help assess the situation and offer advice including obtaining an appointment or admitting the person to the hospital. If you can’t reach someone and the situation is worsening, consider calling 988 to reach your county mental health crisis unit, crisis response team or other similar contacts.

If the situation is life-threatening or if serious property damage is occurring, don’t hesitate to call 911 and ask for immediate assistance. When you call 911, tell them someone is experiencing a mental health crisis and explain the nature of the emergency, your relationship to the person in crisis and whether there are weapons involved. Ask the 911 operator to send someone trained to work with people with mental illnesses such as a Crisis Intervention Training officer, CIT for short.

CIT officers are specially trained to recognize and de-escalate situations involving people who have a mental illness. They recognize that people with mental illnesses sometimes need a specialized response, and are familiar with the community- based mental health resources they can use in a crisis. You can always ask for a CIT officer when you call 911, although they are not available in all areas.

When providing information about a person in a mental health crisis, be very specific about the behaviors you are observing. Describe what’s been going on lately and right now, not what happened a year ago. Be brief and to the point.

For example, instead of saying “My sister is behaving strangely,” you might say, “My sister hasn’t slept in three days, hasn’t eaten anything in over five days and she believes that someone is talking to her through the television.”

Report any active psychotic behavior, significant changes in behaviors (such as not leaving the house, not taking showers), threats to other people and increases in manic behaviors or agitation, (such as pacing, irritability).

Once you call 911, there are two entities that may become involved—medical/first responders and law enforcement.

The NAMI’s full guide to navigating a health crisis also includes sections on preparing for emergency and law enforcement responses, suicide, developing a crisis plan and other helpful information. Again, to obtain a free copy of the full guide, click here.