Managing a Mental Health Crisis: A Family Guide
A mental health crisis is a situation in which symptoms become out of control and a person’s behaviors pose a risk to themselves and others. Family members can make a big difference in the outcome of a crisis by knowing how to recognize it and what to do. After a crisis, getting ongoing treatment is essential for helping a loved one learn how to manage their illness and avoid having another crisis.
If you have a loved one at risk for a mental health crisis, such as someone with a severe mental illness like schizophrenia, be prepared to handle the situation. Know the signs of a crisis, when you need to call for emergency help and when you can de-escalate it yourself. Understand your options and how to get your loved one into the treatment that will help reduce crises in the future.
If you have been living with a family member with a severe mental illness, a crisis may be obvious to you. But if the diagnosis is recent and you aren’t sure what’s normal, what requires a response but not an immediate one, and what constitutes a true crisis can be confusing. It’s important to understand what a mental health crisis is and how to recognize the signs, so you can act quickly to protect your loved one.
Generally, a mental health crisis is defined as a situation in which the way a person is behaving poses a risk of danger or harm to themselves or others. This can include when an individual is incapable of caring for themselves properly. Warning signs can vary by individual, and in some cases there may be none or they may be hard to detect. Typical mental health crisis warning signs you may see include:
- No longer being able to perform normal, daily tasks including basic hygiene and eating regularly
- Rapidly changing moods, which may trigger increased energy or fatigue, extreme happiness or depression, pacing and being unable to stay still, or withdrawal
- Agitation, aggression, violence
- Abuse of others or oneself, including cutting and other types of self-harm
- Paranoia and suspicion or distrust of others
- Losing touch with reality, feeling confused, being unable to recognize people, not understanding what other say, or hallucinating
Children and teens in mental health crisis may exhibit these signs or others. A child may show changes in behavior at school, changing friendships, doing poorly academically, or getting in trouble. Children may also exhibit physical signs of crisis, such as headaches and stomachaches, changes in facial expression, and complaints of generally feeling unwell.
Warning Signs of Suicide Risk
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.
How to Handle Someone Who Is Suicidal
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.
How to De-Escalate a Crisis
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.
Calling for Help in a Crisis
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.
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Getting Ongoing Help after a Crisis
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.
Taking Steps to Prevent a Mental Health Crisis
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.
For the Family
The period during and after a mental health crisis can be difficult for the family and loved ones too. It’s important to take care of your own mental health at this time. As your loved one goes through treatment after a crisis, take steps to participate in any way you can. Most programs involve family through therapy sessions and psychoeducation programming, which teaches you more about mental illness and how to support your loved one.
You may also find that you need a little treatment and support for yourself. Helping a seriously mental ill family member can be overwhelming. Don’t be afraid to reach out for help from a therapist or a support group for people in situations like yours and for family caregivers. The support can make a big difference for your well-being and ongoing ability to help your loved one.
A mental health crisis can be scary and stressful. Knowing what to expect, how to recognize a crisis, and what to do about it can help you cope and be in the best position to help this vulnerable person you care about and love.
If you’re concerned about a loved one and believe they may need residential care, we can help. BrightQuest offers long-term treatment for people struggling with complex mental health illnesses and co-occurring disorders. Contact us to learn more about our renowned program and how we can help you or your loved one start the journey toward recovery.