mental health crisis
What to know and what to expect
A mental health crisis involves:
- The threat of suicide
- The occurrence of an actual suicide attempt
- The threat of harm to another person
- Being guided by audio/visual hallucinations
- A psychotic episode with paranoid thoughts that others are planning to harm the individual
- Rapid mood swings
- Extreme energy or lack of it, sleeping all the time, or being unable to sleep
- Severe agitation and pacing
- Talking very rapidly or non-stop
- Confused thinking or irrational thoughts
The above list contains many but not all the possible signs that you or your loved one may be experiencing in a crisis.
PARENTS: It is best to follow your instincts. Remember you are the expert when it comes to your child. If you feel they are behaving significantly different than normal, or if the situation seems like it is getting out of control and you fear you may not be able to de-escalate it – then they are most likely experiencing a crisis and intervention is crucial.
It can be difficult to know whether to seek medical attention during a crisis by transporting an individual to the hospital by car or to call 911 for immediate help. It can be extremely traumatic for the individual and the family, but it can also be lifesaving. If 911 is called, it is important to tell the operator:
- You are facing a Behavioral Health Emergency (Psychiatric Crisis).
- Request a CIT (Crisis Intervention Team) trained officer that is skilled at helping a mentally ill person in crisis.
- Give as many details as possible about what specifically is happening, and any other background information that may be important.
Emergency services may send both CIT officers and an EMT ambulance who will assess the situation and, if indicated, transport the patient to the closest hospital emergency room for further evaluation.
When someone is in the midst of a severe emotional crisis, they may not recognize their condition as an emergency. However, an individual experiencing a mental health crisis must and can be stabilized under the care of a mental health professional, and an emergency room evaluation and hospitalization may be necessary.
After an evaluation has been performed in the emergency room, if the patient “does not meet criteria” for a hospital admission, they will be stabilized then discharged from the emergency room with instructions to seek treatment in an outpatient setting. If the individual does not currently have a mental health professional, an urgent appointment with a primary care physician should be made for professional support to be found quickly. If the individual does have an outpatient treatment team, (therapist, psychiatrist, etc) they should be informed of the crisis as soon as possible. Do not be afraid to speak openly and frankly with the care team about what is and isn’t working with the treatment plan.
In some cases, it may be deemed necessary for an individual to be admitted to the hospital for up to 72 hours for observation and emergency treatment. This decision is made by the attending physician. Once this determination is made, it may be several hours until arrangements are made for a hospital bed at, and transportation via ambulance to, a facility with an inpatient adolescent psychiatric unit.
Keep in mind there are only 2 facilities in San Mateo county with an inpatient adolescent psychiatric unit; consequentially, it is not uncommon for an adolescent to be sent out of the county for treatment. (Click here for list of facilities in California)
In most cases, parents are not allowed to transport the child themselves or ride in the ambulance with their child but can meet the ambulance at the hospital.
PARENTS: The events which led up to being at the emergency room, as well as the hospital itself can be distressing and overwhelming to both parent and child. Nothing can make a parent feel more helpless than seeing their child in distress while not being able to bring them relief. Also, fear of the unknown can add to an already difficult situation.
Be aware, in the emergency room, family members may or may not be able to stay with the patient. If you are able to stay with your loved one, it is important to remember the following:
- The intensity of the situation can sometimes make it very difficult to control your own fears or opinions so do your best to stay calm.
- Speak gently and slowly in a caring tone.
- Listen actively and do not challenge the patient’s thinking, even if it is irrational or delusional.
- Do not raise your voice or talk too fast.
- Your loved one may be frightened by the feelings they are experiencing.
- Realize that you may have trouble communicating with your loved one.
- Symptoms such as suspiciousness or distorted thinking can cause one to be fearful and not trust other people – even you; try not to take their actions or comments personally.
- Empathize with how your child / family member is feeling. Do not discount their feelings or convince them they shouldn’t feel this way; it can feel dismissive or non-supportive.
- Let them know you love them and are there to help.
If you are not allowed to go in the room with your loved one, let them know that you will be in the waiting room until you hear about their condition. Also, let the Emergency Room staff know how to reach you if needed.
Once moved to a psychiatric unit, the patient will be medicated and stabilized until the crisis has passed. These units generally have a structured routine each day with treatment usually including meetings with the psychiatrist, meetings with a social worker/case manager, and attendance at group psychotherapy sessions. Visiting hours are restricted, and parents / family should confirm what items can/cannot be brought onto the unit (i.e. shoelaces are commonly not allowed, as well as the drawsting on hoodies and sweatpants). Once the patient is deemed safe, they will be allowed to go home with medication and with recommendations for continued treatment.
PARENTS: Be prepared to advocate for your child to receive compassionate, competent and accountable care, if necessary. It is imperative to insist on the following:
- A meeting with the psychiatrist
- A clear understanding of the medications being given
- A well-defined discharge plan before your child leaves the unit.
In the case of teens and children over the age of 18, communication between the care team and the patient’s family / loved ones / support system can be crucial for a positive outcome. Yet, due to privacy laws this can be difficult to achieve. To ensure that the patient’s support system plays an integrated role in the care the patient receives, completing a Psychiatric Advanced Directive before a crisis occurs is HIGHLY RECOMMENDED. (see below)
Psychiatric Advance Directives
A Psychiatric Advance Directive (PAD), is a legal document that allows a second party to act on one’s behalf if they become acutely ill and unable to make decisions about treatment. The PAD is written when one is currently “competent”. It details the individual’s preferences for treatment should they become unable to make such decisions due to their mental health condition. Planning ahead can make a huge difference in one’s treatment experience in the future. (read here for more information on PAD)
If you or a loved one lives with a mental health condition, it’s important to plan ahead. Discuss with the treatment team and loved ones the following:
- Consider options of where to go if stabilization or intensive treatment is needed
- How to get there
- How to take time off work/school or explain the absence to others
- Calming methods which can be used in an emergency
- Family members and friends who would be most helpful in a crisis
- Under what circumstances to call treatment team vs crisis hotline vs 911
- Psychiatric Advanced Directives
Keep written copies of a crisis plan in several places, along with the following information:
- Phone numbers for mental & medical healthcare providers
- Phone numbers of family members or friends who would be most helpful in a crisis
- Local crisis line number (see Crisis Hotline page)
- Address of nearest hospital emergency room
- Diagnosis and medications
- Mental and medical health history
- Completed Psychiatric Advanced Directives
Final Thought
Crisis situations can be stressful, frightening and exhausting for everyone involved. Even if you do everything right and follow all the steps you know how to do to the best of your ability – situations can still get out of hand and may be more than you can handle. Help is available. You are not alone in this.
The following is an article from Palo Alto Online published in May of 2015, regarding a parent’s personal experience of receiving mental health care for her adolescent son in the Bay Area. While this article is several years old, not much has changed since then.
When A Teen Is In A Mental Health Crisis: What Works And What Doesn’t