December 31, 2021
Whether it’s a loved one, a neighbor, or a person on the bus, it can be difficult to know how to help someone who is struggling with a mental health crisis. So, what can you do? We asked Russ Turner, Director of People Incorporated’s Training Institute, for advice on how to help someone during a mental health crisis.
Russ takes us through what a mental health crisis is, what we should do, and when and how to call for help.
What is a mental health crisis?
A mental health crisis is when a person’s behavior is out of sync with the situation they’re in, and they might be at risk of hurting themselves or others. It prevents them from being able to care for themselves or function effectively.
Many things can lead to a mental health crisis – worrying about an upcoming event, a schedule or environmental change, a traumatic incident, etc. Someone in a mental health crisis usually experiences a dreadful feeling of being alone, so the effective response is about connection – not punishment.
How do I know one is happening?
Maintain awareness and notice any changes. Sometimes people stop doing basic daily tasks like bathing, brushing teeth or hair, or changing clothes. You might see rapid mood swings, an increased energy level, or an inability to stay still. Since the stress response is kicking in, you’ll often see signs of agitation – pacing, rocking, destruction of property, verbal threats, and shouting. There may be self-harm behaviors like cutting or substance use, but equally, the person can be suddenly depressed and withdrawn, isolating from others. Sometimes a person may appear suddenly confused, present strange ideas, or cannot understand what you’re saying. They may see things that aren’t there or hear voices in their head.
What should I do?
YOU are the intervention.
Stay calm, pause, and slow down.
Try to figure out what’s going on. Put your phone down, listen, watch, and assess what’s happening. Breathe, slow down, and focus. Pay attention to your nonverbal behavior, present a neutral posture, relax your face, get down to their level (if they’re on the floor for example). Don’t try to make too much direct eye contact and keep your hands down. Stay with or near the person, “I’m going to stay with you, ok?” Talk calmly and quietly. Begin by paraphrasing what the person is saying so they can hear that you’re with them and are concerned about them, “It sounds like you’re worried about the thing, and it’s kind of freaking you out right now.” Validate their emotions, “It’s ok to be anxious,” or “It makes sense that you’re angry.” Turn “no” into “yes.” Instead of “No, calm down!” go with, “Yeah, it’s a really difficult situation.” Try asking simple questions like, “What do you need?” or “Did something happen?” or “Can I get you anything? However, don’t be surprised if they don’t know. If this happens, just validate this response, “Yeah, it’s hard to know.” Tell them you’re there to help and you’re not going to judge them for having a hard time. Use non-stigmatizing simple language like “You’re having a tough time” rather than shaming language like “You’re acting weird.” You can also try distraction, “Hey, do you want a snack?” or “Did you hear about the new thing?”
Because the situation is stressful, you may panic and react rather than crafting a careful and thoughtful response. While trying to set limits, it’s easy to inadvertently threaten the person, adding stress to an already highly adrenalized situation, “If you don’t stop this, then this bad thing will happen!” Your reaction to the crisis elicits a feeling of shame in the person, making them feel worse rather than better, “You should be ashamed.” You may also find yourself asking emotional questions that are further shaming and impossible to answer, “Why are you doing this?” or “What’s wrong with you?”
A common mistake is to try to make the behavior stop immediately, not recognizing that the person is in crisis and doing their best to cope. “Come out of that room right now!” becomes, “I can see that you’re isolating yourself, but do know that I’m right here if you need me.” Although you ARE the intervention, don’t make it ABOUT you, “Why are you doing this to me?” Lastly, you might feel that you’re out of your depth and you leave the person alone or call 911 right away without first trying to connect and de-escalate. Out of frustration, you end up using physical responses like restraint, force or verbal escalation.
Call for help if you are afraid that the situation cannot be resolved, or you are concerned about safety. If working with other professionals like Emergency Medical Technicians (EMTs) or police officers. Tell them it’s a mental health crisis, use those exact words and add more if you need to. “It’s a mental health crisis, they’ve been talking about hurting themself.” Tell them what you think will and will not help. Tell them what you know about the situation and what you’ve done so far. Let any health care professionals know any information you have about what the person is taking including supplements, homeopathic remedies, over-the-counter medications, prescriptions, alcohol, and street drugs to help determine what role they may play in the current crisis episode. All too frequently there can be interactions between substances, including those that are legitimately prescribed.
Other ways to help
Did you know that the Training Institute offers a course on De-escalation? Our trainers will expand on these tips and offer advice for specific scenarios such as what to say to someone who is suicidal, tips for caring for yourself during and after a crisis, and how and when People Incorporated can help.