How to Handle a Psychiatric Emergency

Step-by-Step Guide

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   Step 1: Find out what triggered the psychiatric emergency.

   Ask the person directly what's wrong, and if anyone else is nearby, ask them to provide any details that might help explain what someone is going through.
   
   Here are some examples of psychiatric emergencies:
   Reacting to a traumatic event or flashback Psychosis (losing touch with reality; includes hallucinations) Suicidal thoughts Panic attacks
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   Step 2: Listen closely to the person

   They can provide important information to help you figure out what's going on.
   
   Speak to them calmly and gently, giving them time to process the question and piece together their response.
   
   Are you diagnosed with any mental illnesses or disorders? What was going on right before this attack started? How were you feeling? Do you have asthma? (An asthma attack can look very similar to a panic attack.) Are you on any medications? Do you have any pills or medication nearby to help you deal with this? , They might be able to talk about events that potentially triggered the psychiatric emergency. , Emotions are contagious, and if you act in a collected and respectful manner, it will help the distressed person calm down. , If you're in public, bring them to a more private space.
   
   Feelings of shame and embarrassment about melting down in front of others can make the distressed person feel even worse, so privacy will help them calm down.
   
   Nature especially helps, due to the sunlight and peaceful imagery. , If they say yes, the following techniques can help them relax or reconnect with reality.
   
   Anxiety, Anger, and General Distress:
   Ask them to take deep breaths from their diaphragm (belly).
   
   Hold it for a count of three, and exhale for a count of three.
   
   Repeat until they look more relaxed.
   
   Persistent Worries and Negative Thoughts:
   Help them focus on something else by encouraging them to use imagery.
   
   Ask them to imagine a favorite place they go to.
   
   Then, ask details about the imagery. "What do you see when you stand on the dock?" "What sounds can you hear?" Depression/Suicidal Thoughts:
   Ask them to name their favorite people in the world.
   
   Then, one by one, ask them to list one of each: (1) two good things about that person, (2) two good memories involving that person, (3) two reasons they like that person.
   
   This will take off the edge by reminding them of the good things in life.
   
   Also try asking about locations or hobbies (nothing stressful).
   
   Psychosis and Hallucinations:
   Use "grounding" techniques to help the person reconnect with reality.
   
   Ask them questions regarding their surroundings to engage their five senses.
   
   Lists of grounding techniquesexist online to help you. , Psychiatric emergencies might be frightening to onlookers, but they feel far worse to the person experiencing them.
   
   The person may feel overwhelmed, terrified, frustrated that they can't control their emotions, and ashamed of losing control in front of other people.
   
   Mental illnesses such as anxiety and depression often magnify feelings of shame and guilt.
   
   If there is a glass of water nearby, offer it to them.
   
   Ask before touching them (even if you know them well).
   
   If they feel anxious or are experiencing sensory overload, their brain may interpret it as an attack.
   
   Ask "Do you want a hug?" and wait for their response.
   
   Speak calmly and compassionately to them.
   
   Talk to them the same way you'd talk to an unhappy friend.
   
   This will help reassure them that you are a "safe" person, and that they can calm down. , Mentally ill people aren't inherently violent, and they certainly aren't monsters.
   
   As long as you are gentle and respectful, they are extremely unlikely to lash out at you. , Most mentally ill people are no more violent than the average person, and they will not lash out unless you are acting like a threat.
   
   However, a few people can become violent.
   
   Therefore, it's good to follow a few safety precautions, particularly if the person is angry or severely out of touch with reality.
   
   Don't go to a completely secluded area.
   
   Stay within sight or hearing distance.
   
   Never hold them down or crowd them.
   
   If they aren't thinking clearly, they might interpret it as a threat, and lash out in order to get away.
   
   Don't shout, belittle them, or act in an aggressive manner.
   
   If they feel angry, defuse the situation. , If you get too close, they may panic and push you away or think that you are attacking them.
   
   Don't corner them; give them as much space as they are comfortable with. , Try calling one of their friends, family members, or medical professionals.
   
   They might be able to come over to calm them down, or at least tell you what to do.
   
   If the attack is severe, then call an ambulance.
   
   If the person can't stop hyperventilating, look for signs of oxygen deprivation: blue lips or fingers, bluish skin, coughing, chest pain, confusion, lightheadedness, fainting.If this occurs, call an ambulance immediately.
   
   Call an ambulance if you see any strange physical symptoms that you don't understand, and which the person can't explain.
   
   Don't call the police unless someone is at immediate risk.
   
   Some police are not trained well to deal with mental illnesses, and may injure or kill a harmless person.Call a hospital, health care professional, or suicide hotline. , This includes scissors, knives, pill bottles, guns, razors, and other sharp objects.
   
   Even if someone will be staying with them, it's possible that they could reach for it when the other person turns their back or takes a bathroom break. , Try to help them find their own solution, rather than advising the person.
   
   If you know them well enough, you can offer gentle suggestions, but they are in control of their own destiny. , Offer to sit with them while they contact someone who can help them.
   
   They should not be left alone after an emergency.
   
   Even if they say that they'll be okay, politely insist that they arrange for someone to check on them in a little bit.
   
   Suggest that they call a family member or friend to come with them.
   
   Sit with them while they call a suicide hotline.
   
   If phones are difficult for them, they can use CrisisChat.org, a text-based hotline. , This will help prevent a relapse.
   
   If you can, stay with them, or stay until someone else comes to get them.
   
   Help them plan what activities they're going to do.
   
   Consider movies, art, self care (bathing, massage), going out with a friend, or whatever helps them relax.
   
   If they're going to be alone for any period of time, make sure they have numbers that they can call if they start feeling worse again.
   
   Encourage them to avoid whatever triggered the episode.
   
   For example, an anxious college student might want to take a break from homework until she is back on her feet. , Psychiatric emergencies are very stressful to experience, and it's important to find a way to prevent or reduce the chances of them happening in the future.
   
   Are they getting any medical help? Would they be willing to set up an appointment with their doctor to talk about it? Do they know anything about their medical condition? Have they told their family members and/or close friends? Do they have a support network in place? , You did the best you could, and that alone is admirable.
   
   You are not to blame for what happened, and you were the best friend for them that you could be.
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   Step 3: and ask them questions.

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   Step 4: If other people are nearby

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   Step 5: ask them what happened.

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   Step 6: Stay calm.

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   Step 7: Try a change of scene.

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   Step 8: Say that you know some calming techniques

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   Step 9: and ask if they'd like to do them together.

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    Step 10: Comfort the person.

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    Step 11: Treat them like a human being.

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    Step 12: Be aware that there's a slight chance that they could be violent.

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    Step 13: Don't crowd them.

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    Step 14: Call for help if need be.

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    Step 15: If they're at home

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    Step 16: remove any dangerous objects from the room.

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    Step 17: Help them help themselves.

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    Step 18: Ask how you can help them.

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    Step 19: Help them envision how they'll handle the next few hours.

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    Step 20: If they're open to discussing it

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    Step 21: talk about long-term solutions.

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    Step 22: Whatever the outcome

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    Step 23: don't feel bad about it.

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