Watching someone you love unravel in real time can feel terrifying and helpless. In clinic, families often tell me the same thing: “I did not know what to say, and I was afraid of making it worse.”
You do not have to be a clinician to be a steady, effective support. What helps most is a mix of calm presence, basic safety steps, and knowing which emergency resources to use. This guide walks you through what to do in the moment, what to say, what to avoid, and when to call for urgent help.
First, define “mental health crisis”
A mental health crisis is a period of acute psychiatric distress where someone may be at risk of harming themselves, harming others, or being unable to care for basic needs. It can involve depression , anxiety, panic, psychosis, mania, trauma responses, substance use, or a combination.
Sometimes it builds for weeks. Sometimes it is sudden. Either way, your goal is not to diagnose. Your goal is to reduce immediate danger and connect them to appropriate help.
Common signs someone is in acute distress
- Talking about wanting to die, feeling hopeless, or being “a burden”
- Threats of self-harm or looking for ways to die (pills, weapons, places)
- Severe agitation, pacing, rage, or inability to calm
- Panic with hyperventilating, chest tightness, or feeling unreal or detached
- Psychosis (hearing or seeing things others do not, paranoia, bizarre beliefs)
- Mania (little sleep, pressured speech, impulsive spending, risky behavior, grandiosity)
- Substance intoxication or withdrawal with confusion, aggression, or extreme mood swings
- Not eating, drinking, or sleeping for extended periods, or neglecting hygiene and safety
If you are unsure whether it is “serious enough,” treat it seriously. It is always appropriate to ask directly about safety.
When it is an emergency
Call your local emergency number (911 in the US) or go to the nearest emergency department if there is immediate danger. This includes:
- They have a plan to hurt themselves or someone else
- They have access to means (a weapon, pills, a ledge, car keys while intoxicated)
- They are attempting self-harm or have injured themselves
- They are so disoriented, psychotic, or intoxicated that they cannot stay safe
- They are violent, threatening, or you cannot de-escalate the situation
If you are in the US: 988 can help now
You can call or text 988 (the Suicide and Crisis Lifeline) for immediate guidance, even if you are calling about someone else. They can help you decide what to do next and connect you to local crisis resources.
If you are outside the US, use your country’s emergency number and look for a national or regional crisis line.
How to call 911 in a mental health crisis
If you need emergency services, be specific and practical. Consider saying:
- “This is a mental health crisis.”
- “They are talking about suicide” or “They are threatening someone.”
- “There is a weapon or medication in the home” (only if true).
- “They are not currently harming anyone, but I am worried about immediate safety.”
- “Do you have a crisis intervention trained responder available?”
If it is safe, stay nearby, keep your voice low, and avoid sudden movements while you wait for help.
What to do in the moment
1) Regulate yourself first
Your nervous system sets the tone. Take one slow breath in, then a longer breath out. Relax your shoulders. Speak more slowly than you think you need to. In a crisis, calm is contagious.
2) Check immediate safety
If you can do so without escalating the situation:
- Move to a quieter space with less stimulation (turn down TV, reduce crowding).
- Create physical space if they are agitated. Do not block exits.
- Remove obvious hazards. If appropriate, ask: “Can we put the pills, knife, or keys in another room for now?”
- If there is a firearm present and you can do so safely, follow your household safety plan to secure it. If you do not have a plan, focus on getting professional help urgently.
3) Use supportive, grounding communication
In acute distress, logic and lectures rarely work. Aim for: listening, validating, and guiding toward help.
4) Decide what level of help is needed
Think in terms of urgency:
- Immediate danger: call emergency services or go to the ER.
- High distress but no immediate danger: call or text 988 (US) or a local crisis line, ask about a mobile crisis team, or go to a psychiatric urgent care if available.
- Worsening symptoms but stable: contact their therapist, psychiatrist, or primary care clinician and ask for a same-day plan.
What to say
You do not need perfect words. You need words that reduce shame, increase connection, and gently orient your loved one toward safety.
Supportive phrases you can use
- “I am really glad you told me.”
- “I can see you are in a lot of pain.”
- “You are not alone. I am here with you.”
- “Can you tell me what is feeling unbearable right now?”
- “What usually helps even a little?”
- “Let’s focus on the next 10 minutes.”
- “Would it feel safer if we called 988 together?” (US)
- “I hear you. I also want to make sure you stay alive and safe.”
If you are worried about suicide: ask directly
One of the most persistent myths is that asking about suicide “puts the idea in their head.” It does not. Direct questions can be relieving and life-saving.
You can say:
- “Are you thinking about killing yourself?”
- “Have you thought about how you would do it?”
- “Do you have access to what you would use?”
- “Have you tried before?”
If they say yes, stay with them (or ensure another trusted adult stays), reduce access to lethal means if safe, and contact urgent help immediately.
What not to say
In crisis, certain phrases can increase shame or defensiveness. Try to avoid:
- “You are overreacting.” (Minimizes their experience.)
- “Other people have it worse.” (Adds guilt.)
- “Just calm down.” (They would if they could.)
- “You have so much to live for.” (Can feel dismissive of pain.)
- “If you do that, it will ruin our family.” (Adds pressure, not safety.)
- Threats or ultimatums unless safety requires it (Example: “If you do not stop, I am leaving.”)
Instead of trying to “win” the conversation, aim to keep the connection long enough to reach help.
De-escalation tips
Keep your tone low and your sentences short
When someone’s brain is flooded with stress hormones, long explanations can feel like noise. Try simple statements and one question at a time.
Offer choices to restore control
Crisis can feel like a loss of control. Choices can help:
- “Would you rather sit here or in the kitchen?”
- “Do you want me to call 988, or would you like to text them?”
- “Do you want the lights dimmer?”
Grounding for panic or dissociation
If they are panicking, gently guide:
- Breathing: “Breathe in for 4, out for 6 with me.”
- 5-4-3-2-1: Name 5 things you see, 4 you feel, 3 you hear, 2 you smell, 1 you taste.
- Temperature: Sip cold water, hold an ice cube, splash cool water on the face.
Voices or paranoia
Psychosis can be intensely real to the person experiencing it. The goal is not to argue them out of it. The goal is safety and support.
Do
- Stay calm and speak slowly.
- Validate the feeling: “That sounds scary.”
- Ask about safety: “Are the voices telling you to hurt yourself or anyone else?”
- Reduce stimulation: quieter room, fewer people.
- Seek urgent help if there is risk, confusion, inability to care for themselves, or escalating agitation.
Avoid
- Mocking, challenging, or trying to “prove” they are wrong.
- Whispering with others in the room, which can worsen paranoia.
- Touching without permission.
If substances may be involved
Alcohol and drugs can worsen depression, anxiety, aggression, and impulsivity. Intoxication also raises the risk of accidental injury and overdose.
- If they are passed out, hard to wake, breathing abnormally, turning blue, or having a seizure, call emergency services immediately.
- If they are intoxicated and talking about suicide, treat it as high risk. Stay with them and contact urgent help.
- Do not attempt to physically restrain them unless there is imminent danger and you have no other option. Prioritize getting trained help on scene.
Which resources to contact
988 Suicide and Crisis Lifeline (US)
Call or text 988 for immediate crisis counseling and local resource connection. You can contact them even if you are the friend or family member seeking guidance.
Mobile crisis teams
Many communities have mental health professionals who can come to the home to assess and support. 988 can often tell you whether this is available where you live.
Emergency department
The ER is appropriate for:
- Suicidal intent or a recent attempt
- Homicidal threats or violence risk
- Severe psychosis, mania, or inability to care for self
- Overdose, severe intoxication, withdrawal, or medical instability
Therapist, psychiatrist, or primary care clinician
For worsening symptoms without imminent danger, these are often the best first calls for medication adjustments, urgent appointments, or referral to higher levels of care like intensive outpatient programs.
If the person is a minor
For children and teens, treat suicidal talk or self-harm as urgent. Contact 988 (US) for guidance, call your pediatrician, or go to the ER if there is immediate risk. If your child is at school, ask if the school has a crisis team or counselor who can help coordinate safety planning.
Make a short-term safety plan
Once the immediate storm softens, a simple plan can reduce repeat crises. Keep it concrete and written down.
Include these basics
- Warning signs: “What tells us a crisis is building?”
- Coping steps: 2 to 5 things that help (shower, walk, breathing, music, journaling).
- People to contact: trusted friends or family who can come over.
- Professional supports: therapist, psychiatrist, clinic number, 988.
- Safer environment: plan for securing medications, alcohol, keys, weapons, or other lethal means.
- Where to go: ER, crisis center, a trusted home.
If they do not want a formal plan, you can still agree on one next step: “If you feel like you might hurt yourself, will you text me or call 988 before doing anything?”
If they refuse help
This is one of the hardest situations, and it is common. Start with empathy and curiosity, then offer options that feel less threatening.
Try this approach
- Name what you see: “I have noticed you have not slept and you seem really overwhelmed.”
- Share impact: “I am worried about your safety.”
- Offer a small step: “Could we call 988 for 10 minutes and see what they recommend?”
- Offer choices: “Do you want me to sit with you, take a walk, or call your therapist?”
If they remain a danger to themselves or others, you may need to involve emergency services even if they are angry about it. Safety comes first.
After the crisis
When things calm down, many supporters crash emotionally. That is normal. Crisis care is draining.
Helpful follow-up for your loved one
- Offer practical support: rides, meals, help making appointments.
- Encourage follow-up within days, not weeks.
- Ask what felt helpful and what did not, without judgment.
- Keep checking in: “How are you today, on a scale of 1 to 10?”
Care for yourself too
- Debrief with someone you trust or a counselor.
- Rest and eat something. Your body has been on alert.
- Set boundaries if you are becoming the only support person.
FAQ
Should I leave them alone if they are suicidal?
If you believe there is imminent risk, do not leave them alone. Stay with them or ensure another trusted adult stays while you contact 988 (US), a local crisis service, or emergency services.
What if they say they were “just venting”?
Take it seriously anyway. You can say: “I hope you are right. I would rather overreact than lose you.” Then ask a few direct safety questions and connect them to support.
Can I force someone to go to the hospital?
Laws vary by location, but emergency evaluation may be possible when someone is an immediate danger to themselves or others or cannot care for basic needs. If you are unsure, call 988 (US) or your local crisis line for guidance.
What if calling police will make things worse?
This concern is real for many families. When possible, use 988 to ask about mobile crisis teams or crisis stabilization services in your area. If there is immediate danger, emergency services may still be necessary. When you call, clearly state it is a mental health crisis and ask for a crisis-trained responder.
A final word
In a mental health crisis, your steady presence matters. You do not have to fix everything. Focus on safety, connection, and getting the right help involved. If you are reading this because you are scared for someone you love, please do not carry it alone. Reach out to a crisis line or medical professional now, even if you are unsure what to do next.
