All too often, when bad things occur, we spend hours or days looking back on the situation and wondering what we could have done, what we should have done, to have prevented the situation. Often, we ascribe to ourselves more power than we actually have. Sometimes bad things happen.
This is especially true when it comes to a mental health crisis involving someone we care about. Loved ones can be especially hard on themselves, asking why they didn’t see it coming, why they didn’t do something, why they reacted a certain way. It can be overwhelming, confusing and frustrating for everyone involved.
When someone in your life has a mental health condition, the possibility of a crisis is never far away. A crisis can arise even when the individual is receiving good care, following the treatment plan carefully, and taking medications as prescribed.
As a loved one, it’s important for you to know that you are not alone; there are people available to help you and your loved one; and it’s not your fault if a crisis occurs.
What’s the difference between a crisis and an emergency?
To understand the differences between a crisis and an emergency, it’s important first to understand what mental health is. The World Health Organization defines mental health as a state of well-being in which the individual recognizes his/her own potential; can cope with the normal stresses of life; work productively and fruitfully; and is able to contribute to his/her community.
A mental health crisis occurs when an individual’s state of mind renders them unable to cope with or adjust to the everyday stresses of life. A crisis can be frustrating, but it is not life-
threatening. A mental health emergency is a life-threatening situation in which an individual is threatening immediate harm to self or others, is severely disoriented or out of touch with reality, or is otherwise out of control.
It is rare for an individual to go from good physical health to seriously ill in a matter of seconds. The same is true with mental health. Just as you wouldn’t ignore the symptoms of a physical illness, you shouldn’t ignore the signs of a mental health crisis.
Signs to look for in a mental health crisis:
• Letting personal care slide. The individual may seem unable or unwilling to brush their teeth or hair, change clothes, or take a bath.
• Rapid mood swings. One moment at a 10+ energy level, the next at a minus one. Jumping from ecstatic to depressed and withdrawn very quickly.
• Highly or easily agitated. This may include verbal threats, destruction of property or violent and out-of-control behaviors.
• Abusive to self and others. This includes substance use, and self-harm, such as cutting.
• Isolating oneself from school, work, family and friends
• Seems to be out of touch with the world around them. May have confused thinking or ideas. May be unable to understand others, may feel out of self or feel like they are someone else. Visual and auditory hallucinations.
• Paranoia, including suspicion and distrust of people or actions without any reason.
How to help someone in a mental health crisis
Witnessing a mental health crisis can be unsettling. Try to remain calm and assess the situation. If the individual is in danger of hurting themselves, others or doing serious property damage, or if you believe the situation is or could become life-threatening, call 9-1-1 or have someone else call. Be sure to inform the operator that you are calling about a mental health emergency, not criminal activity.
Some techniques that may be useful in calming the situation
• Speak in a calm and reassuring manner. Avoid overreacting.
• Listen carefully and express support and concern. Remember the person in front of you is ill.
• Avoid making prolonged eye contact. This can cause further agitation.
• Keep stimulus low.
• Move slowly and avoid sudden moves. Don’t touch the individual unless you ask for and are given permission.
• Be patient.
• Offer support and options, not demands and orders.
• Don’t try to argue or reason with the individual. They are not in a state of mind that supports rational thought.
• If the situation escalates or you feel you are in danger at any time, leave the location immediately.
Remember, you are not trying to be a counselor; your goal is to get the individual to a state of calm that will allow them to accept help.
Before it’s a crisis
You may not always be able to see a crisis coming, but you can plan for one. And the time to do it is when all is well. Creating a crisis plan requires open communication between the individual with mental illness and those closest to him/her. Having a crisis plan in place can be reassuring to both the individual and those who care for them.
The mental health experts at Bluegrass recommend including the following elements in a crisis plan:
• Name, age, home address, Social Security Number, insurance cards
• Current diagnoses, a list of medications being taken – name, dosage and frequency, the individual’s physician, psychiatrist or therapist.
• Contact information for family, designated contact and/or trusted individuals
• An outline of strategies and treatments that have worked in past crises. Are there things that help to calm or reduce symptoms?
• A list of people, actions, or things that are likely to make a crisis worse.
• Information regarding previous suicide attempts, substance use disorders, or psychosis
• Anything the individual wants to express regarding treatment choices and preferences
• Names of trusted individuals and supports
Bluegrass is a nonprofit serving children, adults and families in 17 central Kentucky counties with services in mental health, substance use and intellectual and developmental disabilities. Services are available 24 hours a day, seven days a week at the Bluegrass Helpline – 1.800.928.8000. If you, or someone you care about – is experiencing mental health issues, call Bluegrass. We can help.