written by BreakingDownTheWall
- The most important thing is to stay calm.
Even if you are panicking inside, try not to let your unwell friend/family member see it, because it may make their condition worse. Also, if you are panicking yourself, you will not be able to make reasoned decisions on how best to help your friend/family member.
For information on how to calm yourself, click here.
Being calm yourself if the best chance you have of calming them down. You need to enable them to feel relaxed enough to trust you to get them somewhere where they will be safe.
- Listen, and be understanding.
If you’re upset about something and you feel like no-one is listening to you, do you get more upset? But if someone listens to you and is understanding, do you calm down? Mental health symptoms are all related to normal parts of human psychology – if someone doesn’t listen to you you get upset, if someone argues with you you argue back, if something surprises you jump and your heart races. Mental illness causes people to experience more extreme versions of all of those things, but they all have a basis in normal psychology. So treat the person the way you would want to be treated if you were freaked out and upset.
If the person feels like their concerns are being heard, they are more likely to relax. That said, it is very important not to buy into any delusions they may be having.
- Don’t buy into delusions.
To buy into it makes it more real for them and thus increases the delusion’s hold over their mind. Don’t be argumentative, but don’t buy into the delusion. Instead of saying, “No, you’re wrong,” say things like, “That doesn’t sound right,” or “I know that seems real to you right now, but it’s not real for me,” or state simply what is really happening to counteract what they believe is happening.
- Stay with them.
Even if you know the person really well and even if you trust them, remember that when they are in crisis, they are not themselves. That means that they might lie, they might harm themselves, and in a minority of cases they might even harm others. So stay with them if you can, or arrange for someone else they trust to keep an eye on them. Or take them to hospital.
- Be wary of what they are saying and doing.
It’s difficult, particularly if you really care about the person and if you understand that usually the best way forward to mental wellness is to empower the person to look after themselves and make their own decisions. But if they are in crisis, their decision-making capacity is impacted and you might need to second-guess what they are saying or doing and perhaps even force them to go to hospital to keep them safe. (Use of force such as the emergency services must be a last resort. The way to get your friend or family member out of crisis is to enable them to calm down, and using force is the opposite of calm.)
- Be aware of your environment.
Calmly, and not in an obvious way, check where the exits are, where your phone is, and where objects that could hurt someone are (e.g. knives, scissors, sleeping pills, blunt objects). You need to think of the unwell person’s safety. If things take a turn for the worse, they may try to harm themselves, or they may try to run away from you. Take stock of the environment and try to plan what you would do if that happened.
- Make sure you are safe.
Assumptions that mentally ill people are dangerous are absolutely wrong. But when a mentally ill person is in crisis, they are not in control of their own mind, and there have been cases where this has caused others to be hurt. If you know the person well and know that there is no violence in their history or character, you may choose not to worry about this. In the vast majority of cases, the only person a mentally ill person in crisis may harm is themselves. But just be aware, particularly if the person is bigger than you or if you don’t know them very well, of your own safety. This could mean something as simple as making sure that they are not between you and the door.
- Make a reasoned decision about who to call for help.
It’s important you’re not alone in dealing with this and that you have someone to help you. But don’t make the decision on who to call when you are panicking. Think about it in advance – ideally, before a crisis even happens.
- You can talk to your friend/family member about who they would trust most in a crisis situation, and make a plan, with their permission, to call them if needed.
- Make yourself aware of what mental health services are available in your area that can help. Many health services provide 24 hour mental health crisis phone lines. Save the numbers in your phone. If you don’t know the numbers or how to find them, phone your local hospital.
- Calling the emergency services should be a last resort. They are trained in use of force, and that will not help anybody stay calm. The most important thing is to stay calm.
- Get the person to somewhere where they can be safe, and can have a chance to recover.
If the person is suicidal or is suffering symptoms of psychosis such as delusions or hallucinations, hospital may be the only place where they can be safe. If so, it will be a lot better for them if you can take them there yourself rather than calling the emergency services, because the emergency services are trained in use of force, and that will not help anybody stay calm. You need to try and calm your friend/family member down as much as you can; their admission to hospital will be a lot less traumatic if they go in calmly.
If your unwell friend/family member is in a place that is loud, full of people or where dangers like cars or cliffs are present, getting them out of there should be a priority. Take them somewhere calm and quiet, and make sure there is nothing in their vicinity that they could use to harm themselves.
If they are already somewhere calm and quiet and their level of crisis is not reducing, ask yourself whether they will be safe to remain there. If not, you may need to take them to hospital. Before doing this, do whatever you can to try and calm them as much as possible first, and if possible, take them to hospital yourself rather than calling emergency services. (Of course this is only possible if you can keep both of you safe on the way to the hospital – if they have hurt themselves, or if they are in danger of hurting themselves or others, then you probably do have to call the emergency services.) Alternatively, there may be a mental health service in your area that can take them to hospital – if such a service is available in your area, they should be the first people you call. (In Australia, the mental health crisis teams are called the Crisis Assessment and Treatment Teams (CATT) or Psychiatric Emergency Teams (PET), and they are part of the public health system.)
If the crisis level reduces, ask yourself where would be safe for them to spend the night, or the next few nights. If they live with a partner or family member who can support them, and this person has been informed about what’s been happening, you could take them home. If not, you could ask them to stay with you or with another friend or family member they trust, so they can have someone to keep an eye on them. If the person has been suicidal or threatened to self-harm, there are precautions you can take such as locking away knives, medicines (including their own), ropes and car keys. These are of course not foolproof precautions, and if your unwell friend/family member does end up harming themselves while in your house, please don’t blame yourself. You can’t prevent everything. All you can do is mitigate whatever risks you can. If you are uncomfortable with this responsibility or you don’t think you can keep the person safe, you may need to take them to hospital.
If your unwell friend/family member doesn’t want to go to hospital or to stay with someone who can keep an eye on them, and you think the crisis level has reduced enough for them to be left alone, you can take them home, but make sure you check on them regularly. Tell them that you are going to do this, and tell them why. You don’t want them to feel belittled or like you think they can’t take care of themselves, but you do need them to understand that you are concerned for their safety because you care about them, and you want to help them make sure that such a crisis doesn’t happen again.
If your unwell friend/family member is calm enough, you can take them to hospital yourself. The hospital may well be the only place they can be safe. But their admission to hospital will be less traumatic if they go in voluntarily than if they are taken in by the emergency services.
- A word on the emergency services and involuntary hospital admissions
If your unwell friend or family member has hurt themselves, or if they are in imminent danger of hurting themselves or others, then you may need to call the emergency services (000, 911, 999 or whatever the number is in your country). What the person really needs is an ambulance, but please be aware that where mental illness is involved, emergency services will usually dispatch the police as well. That’s because they know that if a mentally unwell person is out of control they may need to use force. This is not good for your unwell friend/family member, and that’s why the emergency services should only be called as a last resort. So even if they are hurt and you do have to call the emergency services, you should still do everything you can to calm them down before they get there, in order to minimise the risk that force will be used.
If your unwell friend or family member is not in immediate danger but they need to go to hospital and you have no way of getting them there yourself, and there is no mental health service available to take them, then yes, you do have to call the emergency services. Just be aware of the points mentioned above.
In this article I have said several times that it is much better to take a mentally unwell person to hospital yourself than to have them taken in by emergency services. This is for two reasons:
- calming them down is the only way they can have the chance to get out of crisis (and introducing the emergency services into any situation generally leads to the opposite of calm – regardless of how well the police conduct themselves, their very presence will raise most people’s anxiety levels)
- their admission to hospital will be a lot less traumatic if they go in voluntarily than if they are taken in by the emergency services. Traumatic events such as being grabbed, restrained or locked away will make your friend or family member more sick, not less sick.
In my case, this lead to my very dear friend’s death, so that’s why I’m banging on so strongly about the emergency services being a “last resort”.
I get triggered writing about that and I don’t want you to be triggered reading about it, so I won’t say anything more other than that the most important thing is to stay calm, and the emergency services and involuntary hospital admissions are the opposite of calm.
I’m not saying don’t call the emergency services at all ever, and I’m certainly not saying that there is no place for involuntary hospital admissions. I’m just saying stay calm and don’t jump the gun.
The best thing to do is to educate yourself in advance about what other options you can take before you need to use that last resort.