Mental Health Crisis Intervention

Recognizing a Mental Health Crisis

For a variety of reasons, mental health issues can be difficult to recognize and address. When people live with chronic, low to moderate levels of depression or anxiety, a new “baseline” emotional state gets established and can actually start to feel normal. Many continue to function superficially well despite their mental health problems because of various mechanisms such as: emotional numbness and denial; compensatory overwork and/or extreme perfectionism; self-medication with caffeine, nicotine and/or alcohol – if not (illegal or misused prescription) drugs; and of course, the “enabling” behavior of family, friends and work associates.

Even when more severe psychiatric symptoms manifest, people might delay seeking help because of impaired thinking/judgement, poor insight or fear of being stigmatized. And some who do recognize the need for treatment receive confusing messages from friends and relatives, who might assume that mental illness can be overcome by simply adjusting one’s attitude or “trying harder.”

People who are in denial about a mental health problem or their need for professional help might only begin to take responsibility when allowed to experience natural consequences. But often, well-intended others enable with the assumption that the person will get better if everyone is more “supportive”, i.e., does not hold him/her accountable for the effects of the untreated psychiatric problem or addiction. For example, if a depressed employee is allowed to come late to work or leave early most days, he/she might have no incentive to get help. And a relative who continues being invited to family events despite becoming drunk & obnoxious each time can remain oblivious to the impact of this destructive behavior.

Whereas some people might respond to direct expressions of concern by seeking help, others will continue to deny until the situation gets out of control. Often, the most effective approach for concerned others is to develop “healthy detachment” (i.e., focus on taking care of yourself, and don’t protect the troubled person from consequences – including more distance in your relationship, if necessary). However, in a crisis which seems to present a direct threat to anyone’s health and safety, a more immediate response might be required. Below are some guidelines to help you differentiate a problem from a crisis:

SIGNS OF A PROBLEM include:

  • Declining educational/vocational or social functioning
  • Apparent depression – sad mood, low energy, sleep/appetite problems
  • Stress-related symptoms – physical, emotional, or behavioral
  • Pervasive worry or anxiety; mild-moderate panic symptoms
  • Indications of alcohol or drug abuse, and related health or legal problems
  • Compulsive behavior (e.g., “workaholism”, eating disorder symptoms, overspending)
  • Possible domestic violence (with adult victim who is not actively seeking help); someone suffering the effects of any past or recent trauma.

SIGNS OF A CRISIS include:

  • Any mention or threat of suicide, up to and including “gestures” or attempts
  • Any threat or motion to harm another person
  • Observed violent or reckless behavior, including property destruction
  • Extreme agitation, anxiety, panic
  • Person seems immobilized by depression, unable to care for self
  • Person seems extremely irrational, confused, illogical (possibly paranoid)
  • Alcohol or drug intoxication/withdrawal that could present an immediate health threat.

How to Respond When Someone is in Crisis

If there has been any violence or aggression (or threat thereof), get to a safe place and call the police. In addition to protecting yourself and others, this can also create another avenue by which the troubled person might get help. If you feel threatened but the situation does no seem to warrant calling 911, you can still contact the police for help with revising a safety plan that could include:

  1. A restraining order;
  2. A psychiatric detention, wherein a magistrate orders that the troubled person be held and evaluated in a secure hospital unit for a specified time period. Many police departments have a victim assistance unit which provides information and support services, even if no criminal charges are being brought.

If the aggressive behavior has been ongoing (or episodic) and directed against a spouse/romantic partner or a child, there are specialized services available for victims of domestic violence and child abuse. Again, depending on how immediate the threat, you can call 911; a non-emergency police number; a mental health crisis center or hotline; child protective services; or a local victim assistance program.

If there has been any type of suicide attempt or gesture, take the person to a hospital emergency room or call for an ambulance – even assured that he/she is “fine.” (If it seems possible that someone might jump from a moving car, don’t transport the person yourself.)

If someone is making direct or indirect comments about suicide, or showing behavioral indications such as giving away their possessions, try to convince the troubled person to:

  1. Contact his/her therapist or psychiatrist if already in treatment, or perhaps allow you to talk with the professional;
  2. Call an emergency hotline or crisis center; or
  3. Go to the nearest hospital emergency room.

If you are afraid to leave someone alone, this means that you probably need to make sure some type of intervention is made (vs. trying to keep your own “suicide watch” or continually worrying about the person while you’re away).

If there is any question of someone being suicidal or potentially violent, try to ensure that there are no guns available. Ask if the troubled person will let you take any weapons and put them in a secure, locked place. If he/she will not relinquish a gun, or if you’re aware of another easy means of suicide such as stockpiled medication, you should bring this to the attention of whatever (mental health or law enforcement) professionals end up getting involved. Also make sure the professional knows of any previous suicide attempts.

Finally, never leave a child in the care of someone who might be suicidal, violent/aggressive or suffering from any serious, untreated mental illness or substance abuse problem.

Other Response Options

  • If your company has an Employee Assistance Program, this can be a good place to get (free, confidential) consultation on how to help someone in crisis. Many EAP’s have 24- hour telephone counseling/referral services available.
  • Call your local mental health crisis center for advice. If there is only a hotline staffed by volunteers, don’t hesitate to ask for the supervising professional to make sure you get the most helpful guidance. Some centers have a “mobile crisis unit”, providing on-site assessment/intervention for psychiatrically impaired persons who refuse to go for help.
  • In crisis situations which involve the police, ask if they can dispatch a team that includes a mental health professional to help address any relevant psychiatric issues.
  • If someone seems severely impaired or unable to care for him- or herself because of mental illness, talk with a primary care physician about treatment options including psychiatric referrals and hospitalization. If a mentally ill person is willing to see an MD but not a psychiatrist, sometimes the doctor can do the initial prescribing & case management – and work towards getting the patient into formal treatment.
  • If there is a child who might be affected by a parent’s mental illness or addiction, consider letting his/her school counselor know of the situation. This will help the counselor be alert to signs that the child is suffering emotionally or is at any type of risk, so that appropriate support services can be made available.

Referrals

  • Montgomery County Crisis Center – 301-315-4000
  • Montgomery County Abused Persons Program – 240-777-4195
  • PG County Hotline – 301-864-7161
  • Frederick County Hotline – 301-662-2255
  • State of MD Helpline – 1-800-492-0618
  • Northern Virginia Hotline – 703-527-4077
  • National Alliance for the Mentally Ill (info/support) – 1-800-950-NAMI or 703-524-7600
  • District of Columbia Helpline – 1-888-793-4357