Category: Health & Safety

Recognizing a Mental Health Crisis & Getting Help

A mental health crisis occurs when someone’s thoughts, emotions, or behavior become so overwhelming that the person may be unable to cope safely without immediate support. The crisis might involve suicidal thoughts, severe emotional distress, extreme confusion, unusual beliefs, panic, substance use, aggressive behavior, or an inability to care for basic needs.

A crisis does not always look dramatic. Someone may be crying or visibly agitated, but they may also become unusually quiet, withdrawn, calm, or disconnected. You do not need to diagnose the person or determine exactly what is causing the behavior. Your job is to notice that something is seriously wrong, respond calmly, and connect the person with appropriate help.

If someone is in immediate danger, has attempted suicide, has a weapon, is experiencing a life-threatening medical problem, or cannot be kept safe, call 911 or your local emergency number now.

In the United States, anyone experiencing emotional distress or a mental health, suicide, or substance-use crisis can also call or text 988 or chat through 988lifeline.org. The 988 Suicide & Crisis Lifeline is free, confidential, and available 24 hours a day.

What Can Cause a Mental Health Crisis?

A crisis can happen to anyone. It may be connected to a diagnosed mental health condition, but it does not have to be.

Possible contributing factors include:

• Depression, anxiety, bipolar disorder, schizophrenia, or another mental health condition
• A traumatic event
• Grief or a major loss
• Relationship, family, school, or workplace problems
• Financial or housing difficulties
• Loneliness or social isolation
• Bullying, abuse, discrimination, or harassment
• Alcohol or drug use
• Withdrawal from alcohol, drugs, or certain medications
• A sudden medication change
• Sleep deprivation
• Chronic pain or a serious medical diagnosis
• Pregnancy or a recent birth
• A neurological condition, infection, head injury, or other medical problem
• Several stressful events occurring close together

Sudden confusion, agitation, hallucinations, or unusual behavior can sometimes have a medical cause. Low blood sugar, stroke, poisoning, medication reactions, infection, head injury, seizures, overheating, and other medical emergencies may resemble a psychiatric crisis.

Do not assume that unusual behavior is “just mental illness,” especially when symptoms begin suddenly or the person also appears physically ill.

Warning Signs That Someone May Need Help

People respond to distress differently. One sign by itself does not always indicate a crisis, but sudden, severe, or worsening changes deserve attention.

Possible warning signs include:

Changes in emotions

• Intense sadness, fear, panic, anger, or hopelessness
• Feeling trapped or believing that nothing will improve
• Severe guilt, shame, or worthlessness
• Rapid or extreme changes in mood
• Emotional reactions that seem unusually intense
• Feeling disconnected, unreal, or unable to cope
• Unusual irritability or agitation

Changes in thinking or communication

• Talking about death, suicide, or wanting to disappear
• Saying that others would be better off without them
• Saying that there is no reason to live
• Confused, disorganized, or difficult-to-follow speech
• Severe difficulty concentrating or making decisions
• Believing that others are trying to harm or control them
• Hearing or seeing things other people do not
• Extreme suspiciousness
• Thoughts that appear disconnected from reality

Changes in behavior

• Withdrawing from family, friends, work, school, or usual activities
• Giving away valued possessions
• Saying goodbye as though they will not return
• Suddenly putting personal or financial affairs in order
• Searching for ways to die
• Obtaining a weapon or collecting medication
• Reckless driving or other dangerous behavior
• Increased alcohol or drug use
• Not sleeping for several nights
• Sleeping almost constantly
• Pacing, shouting, threatening, or appearing unable to settle
• Neglecting food, medication, hygiene, or shelter
• Wandering or becoming lost
• Becoming unable to complete basic daily tasks

SAMHSA recommends seeking help when changes in thoughts, mood, behavior, or physical well-being interfere with daily responsibilities or relationships, particularly when those changes continue or worsen. Suicidal thoughts require prompt attention regardless of how long they have been present. Substance Abuse and Mental Health Services Administration

Warning Signs of Possible Suicide Risk

Take any statement about suicide or self-harm seriously, even if the person says it casually, has said similar things before, appears intoxicated, or later claims to have been joking.

Possible warning signs include:

• Talking about wanting to die or kill themselves
• Looking for a way to attempt suicide
• Talking about having no purpose or reason to live
• Feeling trapped, unbearable pain, or extreme hopelessness
• Believing they are a burden
• Giving away possessions
• Writing goodbye messages
• Contacting people unexpectedly to say goodbye
• Increasing alcohol or drug use
• Acting recklessly
• Withdrawing from other people
• Experiencing extreme mood changes
• Suddenly appearing calm after a period of severe distress
• Having a suicide plan, access to a method, or a specific intended time

A sudden improvement does not always mean the danger has passed. In some situations, a person may appear calmer after deciding to attempt suicide.

Ask Directly About Suicide

If you are concerned, it is appropriate to ask clearly:

• “Are you thinking about suicide?”
• “Are you thinking about killing yourself?”
• “Have you thought about how you would do it?”
• “Do you have access to what you would use?”
• “Are you thinking about doing it today or soon?”
• “Have you already done anything to hurt yourself?”

Use the word “suicide” when that is what you mean. Avoid vague questions such as “You’re not going to do something stupid, are you?” A vague or judgmental question can make it harder for the person to answer honestly.

Do not promise to keep suicidal thoughts secret. The National Institute of Mental Health advises not leaving a person alone if they say they are going to kill themselves and not agreeing to keep the situation secret. National Institute of Mental Health

If the person answers yes, remain calm. Thank them for telling you and focus on getting help.

When to Call 988

In the United States, call or text 988 when you or someone else:

• Is thinking about suicide
• Is experiencing severe emotional distress
• Feels unable to cope
• Is having a mental health or substance-use crisis
• Needs support but is not in immediate physical danger
• Is worried about a friend or family member
• Needs help deciding what to do next

You do not have to be suicidal to contact 988. You can call because you are concerned about someone else, even if that person refuses to call.

A trained crisis counselor will ask about immediate safety, listen to what is happening, offer support, and help identify useful resources. Calling, texting, and online chat are available. 988 Suicide & Crisis Lifeline

For Spanish, call 988 and press 2 or text AYUDA to 988. Veterans and service members can call 988 and press 1 or text 838255 to reach the Veterans Crisis Line.

When to Call 911

Call 911 when there is an immediate threat to life or safety, including when:

• A suicide attempt has occurred.
• The person has taken an overdose.
• The person has seriously injured themselves.
• The person has a weapon and may use it.
• The person says they are about to act on a suicide plan.
• Someone is threatening to seriously harm another person.
• The person is unconscious or not breathing normally.
• There is severe bleeding.
• There is a seizure lasting five minutes or longer.
• The person has sudden confusion accompanied by weakness, facial drooping, trouble speaking, or another possible sign of stroke.
• A head injury, poisoning, low blood sugar, or other medical emergency may be involved.
• The person is severely agitated, violent, or impossible to keep safe.
• You cannot safely transport the person for emergency care.

SAMHSA advises calling 911 or going to the nearest emergency room when someone is in danger or experiencing a medical emergency. Substance Abuse and Mental Health Services Administration

Tell the dispatcher that the situation involves a mental health crisis. Describe the person’s behavior and any immediate risks instead of simply saying that the person is “crazy” or “out of control.”

Provide:

• The exact location
• The person’s name and age, if known
• What the person has said or done
• Whether suicide or violence has been mentioned
• Whether a weapon is present
• Whether medication, alcohol, or drugs may be involved
• Whether anyone is injured
• Any known diagnosis, disability, communication need, or medical condition
• Whether the person has a history of trauma or may react strongly to uniforms, lights, touch, or loud commands

Follow the dispatcher’s instructions. Do not put yourself in danger while waiting for help.

How to Approach Someone in Crisis

Approach slowly and calmly. Whenever possible, have one person speak while others remain nearby without surrounding the individual.

You might say:

• “I’m concerned about you.”
• “You don’t have to handle this alone.”
• “I’m here to listen.”
• “What would help you feel safer right now?”
• “We can call 988 together.”
• “I’m going to stay with you while we get help.”

Speak in a steady voice and use short, clear sentences. Give the person time to respond.

Avoid:

• Shouting
• Arguing
• Threatening
• Lecturing
• Mocking unusual beliefs
• Making sudden movements
• Touching the person without permission
• Crowding or blocking the person
• Demanding an immediate explanation
• Telling the person to “calm down”
• Saying that others have it worse
• Treating the crisis as attention-seeking

Your goal is not to win an argument or force the person to admit that their thoughts are unreasonable. Your goal is to reduce immediate danger and connect the person with help.

Listen Without Judgment

Allow the person to talk if they are able and willing.

Helpful responses include:

• “That sounds overwhelming.”
• “I’m glad you told me.”
• “I believe that you’re in a lot of pain.”
• “Let’s focus on getting through the next few minutes.”
• “You matter to me.”
• “We’re going to find support.”

You do not need to provide a perfect answer or solve every problem. Listening calmly can help the person feel less alone.

Avoid statements such as:

• “You have so much to live for.”
• “You would never really do that.”
• “Think about what this would do to your family.”
• “Just be grateful.”
• “Snap out of it.”
• “You’re being dramatic.”
• “I know exactly how you feel.”

These responses may create shame or discourage honest communication.

If the Person Appears to Be Experiencing Psychosis

Psychosis can involve hallucinations, delusions, severe confusion, or difficulty recognizing what is real. The person may hear voices, see things others do not, or firmly believe something that appears untrue.

Do not argue aggressively about whether the experience is real.

Instead, say:

• “I understand that this feels real and frightening to you.”
• “I’m not seeing or hearing what you are, but I believe that you’re scared.”
• “Let’s move somewhere quieter.”
• “I want to help you stay safe.”

Reduce noise, bright lights, crowds, and unnecessary conversation when possible.

Do not pretend that you also see, hear, or believe something you do not. Acknowledge the person’s distress without confirming the unusual belief.

If the person is following commands from a voice, ask what the voice is telling them to do. Call 911 if the person may hurt themselves or someone else, cannot care for basic needs, or cannot be kept safe.

If the Person Is Extremely Agitated or Aggressive

Keep a safe distance and make sure you have access to an exit. Do not stand between the person and the door.

Try to:

• Reduce the number of people present.
• Lower noise and stimulation.
• Speak slowly.
• Avoid staring or making challenging gestures.
• Give the person physical space.
• Offer simple choices when appropriate.
• Remove children and bystanders from the area.
• Call for professional help early.

Do not attempt to physically restrain the person unless you are trained and an immediate danger makes intervention unavoidable. Physical restraint can cause injury and intensify panic or aggression.

If a weapon is present, do not try to take it away. Move to safety and call 911.

If Alcohol or Drugs May Be Involved

Substance use can increase impulsivity, confusion, agitation, and suicide risk. It can also cause a medical emergency that resembles a mental health crisis.

Call 911 if the person:

• Is unconscious or difficult to wake
• Is not breathing normally
• Has blue, gray, or extremely pale lips or skin
• Has a seizure
• Has severe chest pain
• Is extremely hot, confused, or agitated
• May have taken an overdose
• Has combined unknown substances
• Has seriously injured themselves
• Cannot be kept safe

Do not assume that someone who is intoxicated does not mean what they say about suicide. Take suicidal statements seriously and get help.

Do not leave an unconscious person alone or allow them to “sleep it off.” If an opioid overdose is possible, give naloxone if it is available, call 911, and follow the dispatcher’s instructions.

Make the Environment Safer

If you can do so without placing yourself in danger, reduce access to items that could be used for self-harm.

These may include:

• Firearms
• Medication
• Knives or other weapons
• Toxic chemicals
• Alcohol or drugs
• Car keys
• Ropes or cords
• Access to rooftops, train platforms, traffic, or bodies of water

Firearms should be secured unloaded and locked, with ammunition stored separately, or temporarily removed from the home in a lawful manner. Medication and household chemicals should be locked away.

Do not attempt to remove an item from someone’s hands if doing so could provoke violence. Move to safety and call 911.

Do Not Leave a High-Risk Person Alone

Stay with the person—or make sure another responsible adult remains with them—if they:

• Have said they intend to die
• Have a suicide plan
• Have access to a method
• Have already taken action to hurt themselves
• Are severely confused or disconnected from reality
• Are intoxicated and suicidal
• Cannot agree to remain safe while help is arranged

If you are communicating by phone or text and the person is elsewhere, try to obtain their location. Keep them talking while another person contacts emergency services when necessary.

Do not end the conversation because the person becomes quiet or says they are fine. Continue until appropriate support has taken over.

Getting Professional Help When the Danger Is Not Immediate

A person does not need to wait for an emergency before seeking mental health care.

Possible starting points include:

• A primary care doctor
• A licensed therapist or counselor
• A psychiatrist
• A community mental health clinic
• A school counselor
• An employee assistance program
• A substance-use treatment program
• A local behavioral health urgent-care center
• A mobile crisis team
• A hospital emergency department
• A support group
• A trusted faith or community leader

A primary care doctor can evaluate symptoms, look for possible medical causes, discuss medication, and provide referrals. The National Institute of Mental Health recommends speaking with a primary care provider when you have concerns about your mental health. National Institute of Mental Health

For help locating mental health or substance-use treatment in the United States, contact SAMHSA’s National Helpline at 1-800-662-4357 or visit FindTreatment.gov.

What Information to Share With a Professional

Prepare a clear summary of what has been happening.

Include:

• When the changes began
• What the person has said or done
• Whether symptoms are worsening
• Changes in sleep, appetite, energy, or daily functioning
• Any suicidal or violent statements
• Access to weapons, medication, or other dangerous items
• Alcohol or drug use
• Current medication and recent changes
• Previous mental health diagnoses or crises
• Recent injuries or medical problems
• Major stressors or losses
• What has helped or made the situation worse

Do not minimize the behavior to protect the person from embarrassment. Accurate information helps professionals assess the risk and decide what support is needed.

Create a Safety Plan Before the Next Crisis

A safety plan is a written, personalized plan for what to do when distress begins increasing. It should be created when the person is calm, preferably with a mental health professional or crisis counselor.

A safety plan may include:

• Personal warning signs
• Coping strategies that can be used alone
• People and places that provide distraction or support
• Trusted people who can be asked for help
• Professional and crisis contacts
• Steps for making the environment safer
• Reasons for living
• Preferred hospitals or treatment providers
• Important medication and medical information

Keep the plan where it can be found quickly. Store crisis numbers in the person’s phone.

SAMHSA recommends building a safety plan before a crisis and including warning signs, coping strategies, trusted contacts, professional resources, and ways to make the environment safer. Substance Abuse and Mental Health Services Administration

A safety plan is not the same as asking someone to promise that they will not hurt themselves. A promise alone does not remove the danger or replace professional help.

Follow Up After the Immediate Crisis

Support should not end when the person becomes calmer or leaves the emergency department.

After a crisis:

• Ask how the person is doing.
• Help arrange follow-up appointments.
• Assist with transportation if appropriate.
• Review discharge instructions.
• Help organize medication without changing it.
• Confirm that dangerous items remain secured.
• Encourage sleep, food, hydration, and a manageable routine.
• Help the person reconnect with supportive people.
• Continue taking warning signs seriously.
• Contact a professional if symptoms return or worsen.

Recovery may not happen in a straight line. A person can feel better for several days and then struggle again. Continued support and professional follow-up can help reduce the chance of another emergency.

Take Care of Yourself Too

Helping someone through a mental health crisis can be frightening and exhausting.

After the situation is stable:

• Talk with someone you trust.
• Rest and attend to your own health.
• Set reasonable boundaries.
• Seek counseling if the experience was traumatic.
• Contact 988 if you need support after helping someone else.
• Remember that you are not responsible for providing treatment by yourself.

You can care about someone deeply while still recognizing that the situation requires professional help.

A Mental Health Crisis Checklist

If you are worried about someone:

• Stay calm and speak respectfully.
• Ask what is happening.
• Listen without judgment.
• Ask directly about suicide.
• Find out whether there is a plan, method, or immediate intent.
• Call or text 988 for crisis support.
• Call 911 for immediate danger or a medical emergency.
• Do not leave a high-risk person alone.
• Reduce access to dangerous items when it is safe to do so.
• Do not argue with hallucinations or unusual beliefs.
• Share accurate information with responders.
• Arrange follow-up care after the immediate crisis.
• Seek support for yourself as well.

You do not have to know exactly what diagnosis someone has before asking for help. If a person’s thoughts, emotions, or behavior have become unsafe or unmanageable, treat the situation seriously. Staying calm, listening, asking direct questions, and contacting the appropriate crisis service can help protect someone during an overwhelming moment.

Suggested Guides

• Choosing a Primary Care Doctor
• Explaining Your Symptoms Clearly
• Asking Questions & Speaking Up During Medical Appointments
• Understanding a Diagnosis & Treatment Plan
• What to Do When Someone May Have Overdosed
• What to Do When Someone Is Unconscious

Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.