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Mental Health First Aid or What To Do If Someone You know Is in a Crisis

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Just as anyone can have a medical emergency that requires immediate attention, mental health emergencies are also more common than most people realize. Recently the American Psychological Association published Mental Health “First Aid” guidelines for use by the general public. As in other kinds of emergencies, often the first person on the scene is not a mental health professional. A mental health emergency may involve a sudden psychotic state, panic attack, suicidal or homicidal thoughts, substance overdose, or severe stress reaction. Of course the context of the situation must be taken into consideration. These First Aid procedures are modified from the APA list and work best with people you know and not necessarily with strangers.

  1. Approach the person.

    Don’t ignore the situation or automatically assume they can take care of it themselves. If you see a friend in a crisis, tell them what you observe (e.g., “You look depressed;” “Your words are not making sense:” “You are not acting like yourself;” “You seem really stressed out”) and ask them about it.
  2. Assess the situation.

    You don’t have to be a mental health professional to decide if a situation is serious. Factors to consider:
    Is the person
    talking incoherently or in a way that doesn’t make sense?
    smelling of alcohol or high on drugs?
    sleeping and eating adequately?
    able to go to work or school?
    avoiding people?
    talking about giving up or being unable to face a situation?
    acting unusual or out of character?
    displaying unusual or extreme emotions?
    making threatening statements to self or others?
  3. Assist with the crisis.

    Let the person know you are there to help. If the person is incoherent, ask
    • “Do you know where you are?”
    • “Can you understand me?”
    • “Do you recognize me?”
    • “Do you know what day or time it is?”
    • “Have you swallowed anything, pills, drugs, alcohol, anything else?”
    • “How long have you been like this?”
    Call 911. If the person is coherent, ask them to talk about what is going on with them right now.
  4. Listen nonjudgmentally.

    Ask the person to describe their feelings and their thoughts. Remember that you are obtaining information and not giving advice.
  5. Offer support.

    Let the person know you are there to listen and be helpful. Offer reassurance that you will stay with them until they feel safe or you can get them other help. Stay calm yourself and speak in a clear, steady manner. Don’t make promises such as “Everything will be all right” or “I will take care of you.” Most of all, just listen.
  6. Offer information.

    People experiencing psychosis often don’t know what’s real. They may be delusional, thinking something unreal is about to happen or that they are not safe. Tell them where they are, what time and day it is, remind them who you are. Point out the safeguards around them. Suicidal people often believe they have done something wrong and deserve to die, or that they are trapped and have no other option. Homicidal people often believe someone else deserves to die or is an immediate threat to them. Don’t argue with them but point out other options besides suicide or homicide. Remind them that there is time to rethink their decisions.
  7. Encourage the person to get professional help.

    If the person is incoherent or a threat to self or others, call 911 or the crisis line yourself. You may have to take them to the Emergency Room at the local hospital, where someone from the local mental health authority will be called in to conduct an evaluation. If the person is already in treatment with a professional, you may want to get the name of that person and call the professional’s office or answering service, giving your name, contact information, and information about the crisis. If the person in crisis is coherent and open to talking to you about their problems, listen to them and then encourage them to call a professional. You may want to get the telephone number yourself and help them make the call, or accompany them to the first visit.
  8. Encourage other supports.

    If the person is coherent and willing to talk, suggest contacts with other friends and family who may be supportive and can help the person feel safe and supported. Ask the person about groups they already belong to but may have been avoiding, such as church groups, 12 step programs, clubs, recreational or interest groups, where they will have people around them. Become aware of self-help groups or mental health organizations such as the National Alliance on Mental Illness (NAMI) in your community that might provide regular support and check-ins.

References

Jorm, A.F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67, 231 – 243.

Kitchener, B.A., Jorm, A.F. & Kelly, C.M. (2010). Mental Health First Aid Manual Melbourne, Victoria, Australia, Orygen Youth Health Research Centre