If you or a loved one is in crisis now, please consider the communities below who have advanced training and insight into the resources available. More communities are available by clicking here.
- Call 988 or 800-273-8255
- TTY users please use your preferred relay service or dial 711 then 1-800-273-8255
- Telephono 888-628-9454
- Text NAMI or HOME to 741-741
- Call 800-799-7233
- Call 800-273-8255 then press 1
- Text 838255
- Call 800-232-4636
- Call 800-422-4453
Understanding the Experience of a Mental Health Crisis
A mental health crisis occurs when we’ve lost our ability to cope with, and problem solve, a situation of great personal importance. Understood to have three components, a crisis begins with a triggering event, grows in proportion based on the meaning we ascribe the event, and then elevates to catastrophic levels when our adaptive coping strategies fail us (Weiner, 2010).
Every single one of us is capable of entering a crisis given the right internal forces, external forces, circumstances, physical conditions, and series of events. Each human person has limited resources and coping strategies, and disequilibrium can occur within us all (Weiner, 2010).
When we are within such a crisis, we are experiencing an emergency. Our cognitive, emotional and behavioral functioning is reduced and we may become a danger to ourselves or others. In this state, we may be considered gravely disabled and we require support and interventions in order to remain safe (Weiner, 2010).
As we come out of our crisis situation, we will be changed by it for better or worse. We will experience personal growth or we will experience a loss of functioning that can lead to decline over time (Weiner, 2010).
When working to understand a mental health crisis, there is basic knowledge that we can use to create a foundation. This information is presented below (Weiner, 2010):
- Mental health crises typically have a sudden onset and unpredictable nature.
- We cannot prepare for, nor expect, when they will occur.
- Certain crises are the result of an accumulation of events or stresses.
- Milestones in our lives (graduation, marriage, retirement) make us vulnerable to a crisis.
- Mental health crises resolve fairly quickly.
- We are not capable of sustaining the crisis level of stress indefinitely.
- On average, we exhaust ourselves after 36 hours.
- It is rare for a crisis to last longer than two weeks.
- Mental health crises are the result of a loss of psychological equilibrium.
- Our current coping mechanisms are not enough to return us to our balanced state.
- We are especially vulnerable to the suggestion of alternative coping strategies.
- This may manifest as a higher willingness to accept help or we may become more closed off.
- We may feel motivated to harm ourselves or others or use substances in excess.
- A mental health crisis is not a mental illness.
- While symptoms may appear identical, a crisis will dissipate over time while a mental illness is long term.
- We are all unique in how we experience a mental health crisis.
- Our society, culture, ethics, values, spirituality, health and living conditions all influence how we experience a crisis.
- A mental health crisis can be alleviated in part through crisis intervention.
- Distinct from psychotherapy, crisis intervention is the use of strategies and resources to reduce suffering now.
Identifying a Crisis
When someone is in crisis, they typically demonstrate a very obvious and sudden change in their pattern of behavior. Examples of such changes include (APA, 2013):
- Loss of interest in maintaining hygiene.
- Drastic changes in sleeping patterns.
- Sleeping too much or insomnia.
- Onset of nightmare or night terrors.
- Drastic change in eating habits.
- Eating too much or loss of appetite.
- Weight gain or weight loss.
- Significant loss of function at home, work or school.
- Sudden mood swings and extreme moods.
- Withdrawal from activities, routines, relationships and responsibilities.
Certain individuals are more vulnerable to stressors and more likely to have a crisis response to those stressors. Be alert to the impact of stress on the following groups (Weiner, 2010):
- Those at developmental milestones.
- Those with chronic health conditions and pain.
- Those who have disabilities.
- Those with significant life stressors.
- Those who have survived trauma.
- Those without strong social support.
- Those who have limited coping skills.
- Those who place high expectations on themselves.
- Especially perfectionists
- Those who are struggling with their status within their family.
- Those who are displaced from their ethnic group and culture.
- Those who will suffer employment consequences as a result of a stressor.
- Those who have a harsh or self-deprecating perception and interpretation of a stressor.
When engaging someone who is in crisis, our goals are to ensure physical safety, seek out and implement the use of stabilizing resources, and support the person as they return to a normal level of functioning (Weiner, 2010).
We can work to meet these goals by using the following crisis intervention guidelines (Potter, 2020):
- Assessment of their condition and needs.
- Is this person a danger to themselves or others?
- If yes, return to the top of this page for access to crisis lines who can help.
- Does this person have an immediate medical need?
- Do they have an untreated medical condition?
- Are there medications they’ve been prescribed that they need to take?
- Does this person have an immediate physical need?
- Do they need to breathe deeply and slowly to catch their breath? Do they need food? Water? Rest? Shelter? Warmth? Cooling? Sexual release?
- What are their protective factors?
- Physical - Do they have access to money? A home? Transportation? Health insurance? Employment? Friends? Family?
- Emotional - Have they been resilient in the past? Do they have adaptive coping strategies? Is there a way to relieve physical tension through physicality?
- Click here for more on resiliency.
- Click here for more on adaptive coping.
- Click here for more on physicality.
- Social - Do they have a supportive family? Do they have a supportive community?
- What are their individual needs, abilities and preferences (Weiner, 2010)?
- What cultural or spiritual beliefs and values need to be incorporated?
- Build rapport.
- Rapport is the ability to communicate effectively through the use of empathy and trust. Click here for quick access to therapeutic communication.
- Identify the triggering event.
- What happened?
- What meaning does the event have for the person in crisis?
- Understanding emotions.
- Explore alternatives.
- Identify their strengths and resources.
- Identify their emotional triggers and ways to reduce exposure.
- Identify coping skills they’ve used in the past.
- Create an action plan.
- What is the least invasive and least restrictive path forward?
- What are their goals in the short term? Long term? Lifetime (Weiner, 2010)?
- Who will they reach out to? How can that person help?
- How will we know the crisis is over?
- Create a follow up plan.
- How can we provide self care after the crisis is over (Weiner, 2010)?
- What actions come after the resolution of this crisis?
- How can we reinforce the use of coping strategies to prevent or reduce suffering from a future crisis?
When those close to us are struggling, the thoughts being heard internally may drown out or alter the ideas we are trying to share and they may find it difficult to accurately identify the intentions and emotion behind our words. Because of this, it is important to choose the language, topics, and tones we use carefully, and speak in a way that facilitates mutual respect and understanding (Potter, 2020).
When working with someone in crisis, how we choose to interact in those critical moments can define the path they take to either grow past the event or decline in functioning over time. If we withhold our compassion, meet them with shame or neglect, or deny them timely help, there is a possibility that a crisis can develop into a mental health challenge (Weiner, 2010).
A helpful strategy in building a foundation of trust with someone who is struggling is to take on the perspective of unconditional positive regard (UPR). UPR uses a foundational attitude of active, positive acceptance and a goal of preserving the dignity and self-respect of all parties involved. Within this environment, value judgments are suspended and the self worth of the person in focus is emphasized. This person is encouraged to identify parts of their life where they can employ proactive acts of self-determination to improve their condition or meet their goals (Potter, 2020). For more information on UPR, click here.
How we carry our bodies, and manage our own emotions, during these conversations is paramount in demonstrating we are safe people who are there to help. Consider using the strategies below prior to, during, and after the conversation (Potter, 2020):
- Offer the Self - this is how we can show that we are willing and available to provide support. ‘I am here for you if you need me.’, ‘I want to know how I can help you.’
- Empathy - the conscious act of viewing the situation from the perspective of the person we are talking to. Here we attempt to feel their emotions, needs and experiences in order to develop a deeper connection and understanding.
- Neutrality - placing aside our own perspectives, we attempt to engage the person we’re speaking to objectively and without passing judgment. The goal here is to hear and accept the information provided without approving or disapproving. Allowing what is said to be true from their perspective and creating space to test out thoughts, feelings and behaviors without discouragement or consequences.
- Self-Disclosure - though we may be tempted to relate to the person we’re talking to by sharing our own similar stories in-depth, this act tends to turn the conversation away from them and toward us. Alternatively, we can share short talking points that directly relate to what we’re hearing. These talking points may describe what we experienced, how we reacted, how we felt, as well as what our opinion was at the time and it is now. This is in an effort to provide an alternative, outside perspective on complex situations.
- Suggest Ways to Collaborate - here we think of ways that the person we are talking to can receive help from others in order to reach their goals. We’re not passing them off, but instead reminding them of the people in their lives who can act as a support and a resource to ensure they are socially connected.
Compassionate and productive dialogue is facilitated by intentionally demonstrating that we are engaged. Consider the list of techniques below when trying to show those close to us that we are engaged in what they are trying to say (Potter, 2020):
- Use a Broad Opening - start the conversation with an observation and a request to learn more. ‘I can see that you’re upset. May I ask why?’, ‘You don’t seem like yourself right now, has something changed?’, ‘You’ve been angry/withdrawn/frustrated lately. Can we talk about it to see if I can help?’
- Active Listening - here we turn off or tune out distractions and give our full attention to the person speaking. Do not rush them, and participate fully in the conversation at hand. We use our words and body language to communicate our interest.
- Make Eye Contact - using eye contact ensures we communicate that we are paying attention.
- Use Incomplete Sentences and Brief Questions - this creates a gap in the conversation that shows we are listening and that we want more information, while making room for them to add their input and stay on track. ‘You were in class and…’, ‘You saw it in the house and…’
- Make an Observation - here we think about what their body language is saying, and share that observation with them. ‘I can see the tension in your shoulders’, ‘Telling me that made you tear up’, ‘You keep looking at the clock and door.’
- Use Open-Ended Questions - this tool aids us in opening up dialogue, while allowing the person we’re talking with to define their focus and direction. ‘How did you feel after that happened?’, ‘What caught your attention when you were there?, ‘Who was with you?’, ‘Then what happened?', ‘Who do you usually want to talk to about moments like that?’
- Repetition - this is where we simply reflect what was said to us in an effort to communicate that we are present and listening. ‘You were alone in the room for hours.’, ‘You are worried that there is permanent damage that can’t be undone.’, ‘You feel intimidated/isolated/unable to stop.’
- Paraphrase Their Words - here we can communicate that we heard them, internalized their words, and have developed our own understanding of what they meant. ‘You felt isolated in that moment and wanted to run out of there’, ‘The bullies at school kept following you and you felt trapped’, ‘The words I said reminded you of a fight we had and that made you feel defensive.’
- Use of Silence - as much as we want to fill in the words others are trying to find, when we do so, we take away their voice and their agency, while communicating a lack of care and patience. Fight the urge to fill in the gaps, and let them linger. This creates room for the person we’re listening to to add more without pressure.
When engaged in conversation with someone who is struggling, it is helpful to not let the conversation revolve around negative self-perceptions or thoughts that are damaging or unproductive. This can lead to rumination and perseveration, which serve to enhance unpleasant emotions. To prevent this, we can use insight oriented techniques that direct the conversation toward self-reflection and understanding. Examples of insight oriented techniques are described in detail below (Potter, 2020):
- Encourage Comparison - ask the person to think of events in the past that are similar or different to what they are experiencing now. Did they react the same or differently? Did they feel the same or differently? What important factors were the same in those events? What important factors were different?
- Encourage Detailing Perception - ask them to elaborate on what they smelled, heard, felt, saw or thought. This facilitates a deeper understanding of what stood out to them about the event and what gave the event importance.
- Identify Themes - make observations about patterns or commonalities within the problems being presented or within the reactions to the problems being described. Consider framing themes using the following language: ‘I've heard you describe your coworkers as ‘out to get you’ a few times so far. Can we talk more about what's made you feel that way?’, ‘You’ve shared the idea of feeling alone or isolated from your classmates a few times, and I can see how much that hurts you.’, ‘You feel very strongly about your friend moving away and I wonder if you’ve felt this way before?’
- Present Reality - we are not trying to dismiss their reality, but instead find a mutually agreeable reality that creates a foundation of understanding. This involves presenting the world as we see it. Consider the following phrases: ‘You’ve shared that you feel your neighbor is intrusive and disrespectful. I’m seeing these intrusions as an attempt to connect with you by someone who wants to get to know you better. Maybe there is compromise there?’, ‘I can see that the chore chart is making you feel negative emotions. My reality is that I need help from you. If we don’t use the chore chart, what tool can help meet both our needs?’
- Reflect - here we think about what aspects of the conversation or their body language stood out to us as unclear or conflicting. If we don’t understand what they meant at certain points in the conversation, it may be true that they don’t fully understand what they meant either. Ask about those inconsistencies to elicit an alternative explanation and perspective. ‘You said you felt disappointed, but your body language told me you were angry. Can we talk about that?’
- Reframe - now we use our own perspective to reframe the context of the conversation. For example: ‘I hear you say that you’re giving up by ending this relationship, but it seems to me that you are choosing to invest in your relationship with yourself instead.’, ‘The loss of this career path was difficult, but I’ve seen you make time for yourself in a way that reduces the stress you carry each day.’
- Translate Their Body Language into Feelings - because we are a third party observer, we have a unique perspective on their body language and tone. Consider acknowledging those cues to them in the form of a statement. ‘You looked defeated when you described the fight with your spouse to me just now.’, ‘It sounded to me like you feel a strong sense of guilt over how your time spent with your friend went.’
- Verbalize Implications - here we take time to interpret the indirect messages and impressions felt from the information being shared with us. ‘Once you started this new job, it seems like you felt inadequate or unworthy. Is that the case?’, ‘I heard you when you mentioned that you were angry at your spouse for remarrying. Is it possible you felt left behind or replaced?’
- Voice a Sense of Doubt - though not always easy, it is important to push back on some forms of negative thinking in order to communicate that we don’t endorse their train of thought. For example: ‘I don’t agree that you failed your family, because I see that you did…’, ‘I’m not seeing your actions the same way you are, I see you as having done well because…’, ‘You seem to think it was all your fault, but I think others had a role to play that you’re not considering fully.’
Within these conversations are opportunities to direct future efforts and reduce the sense of totality and finality that can come from crisis level thinking. Consider providing information about what actions or experiences they may benefit from and make plans with them. Suggest options for next steps, and promote hope for the future. Consider using humor to lighten the mood and relieve tension. For information on how to use humor most effectively, click here.
Advice by Challenge
Click on the links below to be directed to a page containing information on each unique challenge. Strategies to help overcome each challenge, and insight into how to help someone experiencing them, is located near the bottom of the page.
- Anger and Aggression
- Antisocial Behavior
- Depersonalization and Derealization
- Grief and Loss
- Guilt and Shame
- Intergenerational Trauma
- Obsessive Compulsive Behavior
- Power and Control
- Psychological Pain and Suffering
- Substance Abuse
- Suicidal or Homicidal Thoughts
It is critical that we make every effort to maintain our own equilibrium throughout the process of crisis intervention. We cannot help others if our own needs are unmet and we can’t offer support when we are lacking the support we need. Please take a moment to visit the strategies page of this website in order to find ways to build up internal resources and resiliency in the face of conflict. That page is available by clicking here.
One strategy that is critical to our own sense of internal balance is setting limits and boundaries. We do so not to punish others or push them away, but to preserve our energy and our internal capacity. Click here for more information on limits and boundary setting.
Keep in mind that we cannot force someone to be introspective, engage in therapeutic communication or make an effort to resolve a crisis. As painful as it is, we cannot heal someone who is not willing to heal themselves. If the person we are working with is actively choosing not to work with us, the only option may be to walk away from them in order to protect ourselves.