Navigating a Mental Health Crisis

If you’ve experienced a mental health crisis in the past, you may want to plan ahead in case a crisis happens again. Planning ahead can help make sure your preferences are known and honored during the crisis, and may also help interrupt things before they get to a crisis level.

Resources you can use for wellness and crisis planning…

• Wellness Recovery Action Plan
• Madness & Oppression: Paths to Personal Transformation & Collective Liberation (pdf)
• Making a Self-Care Plan
• A New Kind of Safety Plan
• Psychiatric Advance Directives: Forms to Prepare (pdf)
• Safety Plan (google doc)

A mental health crisis is when someone is experiencing symptoms that make them feel out of control or make it hard for them to care for themselves. It can look different for different people. For example, thinking about suicide, hearing voices, or having unusual thoughts can be part of a mental health crisis for some people, but other people are able to manage these experiences.

You get to decide when what you’re experiencing has reached a crisis level for you.

Ask yourself what you need – or don’t need – right now… Is there something you can do to make yourself feel better or distract yourself? Do you need the company of someone else, or would time alone be helpful? Also ask yourself when you last ate or slept. Sometimes we neglect basic needs when we are struggling, and that can worsen what we are experiencing.

You can try doing something that makes you feel good or that distracts you from what you’re experiencing. Know that self-care looks different for different people, and your self-care needs can change moment to moment. Do what works for you right now.

Need some ideas? Check out this list (pdf)!

You can also check out Things That Helped When the Despair Got Big + Loud (google doc), a collection of ideas from people who’ve been there.

The focus is on you. Your number one priority right now is taking care of yourself.

If you think that you can’t manage this alone, reach out to a friend, family member, or other person you trust for support. Not sure what to say when you reach out? Read 10 Ways to Reach Out When You’re Struggling with Your Mental Health for some ideas.

If you think it would be helpful to talk to someone who has had their own journey with mental health and “gets it,” peer support can be a great option! You can try one-on-one support or a support group. You can find support options here.

If you don’t have someone to reach out to – or think that talking with someone you don’t know would be helpful – you could try a crisis call, text, and chat service. Their operators are trained to provide support and resources to people who are experiencing a crisis. If you are concerned about privacy, you can call using a Voice Over Internet (VOIP) service, or chat while using a virtual private network.

Check out this list of crisis call, text, and chat services (pdf).

If you’re already getting care from a mental health provider like a therapist or psychiatrist, you may want to reach out to them for more support. Many mental health practices offer urgent care for their patients, either with your provider or another provider in the practice. If you feel like you need more intensive support, your mental health provider can also help you set up that care.

You can get support from a community crisis response team, if there’s one in your community. Community crisis response teams are staffed by trained non-police responders. They offer emotional support, resource connection, and more.

• Amherst Community Responders for Equity, Safety, & Service
  Call 413-259-3370
  Monday through Friday, 8 am to 4 pm
  Saturday, 10 am to 6 pm
• Northampton Department of Community Care
  Call or text 877-322-0413
  Monday through Friday, 8:30 am to 4 pm
• Cambridge HEART
  Request support

Peer-led crisis programs offer short-term support – a few hours to a few days – in a non-clinical, home-like environment and serve as an alternative to clinical treatment options like community crisis stabilization programs and inpatient hospitalization. They are led by peer supporters, people who have experienced mental health symptoms, have been diagnosed with a mental health condition, have received mental health services, or have similar “lived experience.” Some peer-led crisis programs offer mobile support, meaning the support comes to where you are.

Peer-Led Crisis Programs in Massachusetts…

• Afiya in Northampton
  hosted by the Wildflower Alliance
• Karaya in Worcester and mobile
  hosted by Kiva Centers
• Juniper in Bellingham and mobile
  hosted by Kiva Centers
• La Paz in Dudley and mobile
  hosted by Kiva Centers
• The Living Room in Framingham
  hosted by Advocates, Inc
• The Living Room in Springfield
  hosted by Behavioral Health Network

If you need to speak with a mental health provider urgently about what you are experiencing, behavioral health urgent care and Mobile Crisis Intervention teams are available.

Behavioral Health Urgent Care

Behavioral health urgent care is designed to provide people with easier access to care, with same-day or next day evaluation and referrals to further treatment.

If you have MassHealth, you can use this list to learn more about behavioral health urgent care and find an urgent care site.

If you have other health insurance, contact your health insurance plan to determine if behavioral health urgent care is a covered service and a list of providers.

Substance Use Urgent Care Clinics

If you need urgent substance-related care, you can try a substance use urgent care clinic.

• Boston Medical Center’s Faster Paths to Treatment in Boston
• Brigham Health’s Bridge Clinic in Boston
• Harrington Hospital’s Addiction Immediate Care in Webster
• Massachusetts General Hospital’s Bridge Clinic in Boston
• South Shore Hospital’s Bridge Clinic in Weymouth
• SSTAR’s Opioid Triage Center in Fall River

Mobile Crisis Intervention (MCI) teams

Mobile Crisis Intervention (MCI) teams are based at local Community Behavioral Health Centers (CBHCs) and are staffed by mental health clinicians and peer supporters. They can talk to people who feel they are in or near crisis, and try to help them find the support they need to manage the crisis. This can mean getting short-term support from the MCI team, staying in a crisis stabilization bed, participating in a more intensive program like a Partial Hospitalization program, and being connected to ongoing care. If psychiatric hospitalization is needed, the MCI team can search for an inpatient bed.

MCI services are available 24 hours a day, 7 days a week, 365 days a year. You can call the statewide Behavioral Health Helpline to be connected with the MCI team serving your area.

Behavioral Health Helpline
call or text 833-773-2445
chat online at www.masshelpline.com

Community Behavioral Health Centers (pdf)

If you need to speak with someone urgently about what you are experiencing and other options are not available (or your crisis involves a medical emergency), you can go to your local hospital emergency department. While in the emergency department, providers will assess you to determine next steps.

Know that the care options that can be offered in the emergency department are often more limited than what an MCI can offer, and your ability to choose the care that you think will work best for you may be limited.

If the person you are supporting has experienced a mental health crisis in the past, you can encourage them to plan ahead in case a crisis happens again. Planning ahead helps make sure their preferences are honored during the crisis, and can sometimes help interrupt things before they get to a crisis level. Resources they can use for wellness and crisis planning…

• Wellness Recovery Action Plan
• Madness & Oppression: Paths to Personal Transformation & Collective Liberation (pdf)
• Making a Self Care Plan
• A New Kind of Safety Plan
• Psychiatric Advance Directives: Forms to Prepare (pdf)
• Safety Plan (google doc)

A mental health crisis is when someone is experiencing symptoms that make them feel out of control or prevent them from being able to care for themselves. It can look very different for different people. For example thinking about suicide, hearing voices, or having unusual thoughts can be part of a mental health crisis for some people, but other people are able to manage these experiences. Try to rely on the wisdom of the person you are supporting and how they interpret what they are experiencing.

It’s natural to feel scared or overwhelmed when someone you love is experiencing a mental health crisis. It can be hard to know what to do. Here are some general things to keep in mind…

• Keep calm and avoid over-reacting. Also try to avoid centering your own experience.
• Offer to listen, then listen without judgment. Avoid making assumptions about their experience. If you don’t understand something they said, gently ask what they mean. You can offer the person validation with what they’re feeling, and try not to minimize it.
• Respect if they don’t want to talk. It can be hard to open up about what you’re experiencing. Offer just to sit with them.
• Know that most people are looking for support, and not advice. Understand that your role is to support the person and not to “fix” them.
• Avoid deciding what’s best for them, making decisions on their behalf, or pressuring them to do or not do something. Ask the person what would be helpful, instead, then do that.
• Encourage self-care and taking care of basic needs. You can ask having something to eat or drink would be helpful.
• Admit when you don’t know what to say. It’s okay to just spend time with someone and be present.
• If the person you’re supporting is perceiving things that you do not, it’s generally not helpful to say that they’re wrong (unless the person has told you that reality-checking with you is something they find helpful). Understand that the experience is real for them. You don’t need to pretend to experience what they are, but you can validate the pain, anger, fear, or other emotion that they are feeling.
• For some people, talking will help them move through the crisis. Other people may need more support. With the person’s consent, you can offer to help them find the support that will work for them.

With the person’s consent, you can offer to help them find the support that will work for them. Here are some potential support options…

• Getting peer support, if talking to someone who “gets it” would be helpful. There are many options for getting peer support in a group and for one-on-one peer support.
• Using a crisis call, text, or chat service. They can provide support and resources to people who are experiencing a crisis.
• Talking to their mental health provider, if they are already getting care from someone. Many mental health practices offer urgent care for their patients, either with the patient’s provider or another provider.
• Getting support from a community crisis response team, if there’s one in their community. Community crisis response teams are staffed by trained non-police responders. They offer emotional support, resource connection, and more.
• Use a peer-led crisis program. Peer-led crisis programs offer short-term support – a few hours to a few days – in a non-clinical, home-like environment and serve as an alternative to clinical treatment options like community crisis stabilization programs and inpatient hospitalization.
• Get support from urgent care or the local Mobile Crisis Intervention (MCI) team. Behavioral health urgent care is designed to provide people with easier access to care, with same-day or next day evaluation and referrals to further treatment. Mobile Crisis Intervention (MCI) teams are based at local Community Behavioral Health Centers (CBHCs) and are staffed by mental health clinicians and peer supporters. They can talk to people who feel they are in or near crisis, and try to help them find the support they need to manage the crisis.
• Going to the local Emergency Department, when other options are not available, or the crisis involves a medical emergency. Know that the care options that can be offered in the emergency department are often more limited than what an MCI can offer, and the ability to choose the care that they think will work best for them may be limited.

Try to avoid calling 9-1-1 if possible, when it is not a medical emergency or there is no danger of immediate harm. If you do decide to call 9-1-1, you can tell the dispatcher that you are calling about someone who is experiencing a mental health crisis.

Ideas for Supporting Someone who Uses Self-Harm (pdf)

Supporting Someone who is Thinking about Suicide (pdf)

Supporting someone who is experiencing a crisis can take a lot of energy. It’s important to also think about your own needs. Make sure you’re taking care of your basic needs, like eating and sleeping. You may also want to try doing something that is positive or relaxing. You can find other ideas for self-care here (pdf).

You can also try family support. Know that most family support options welcome all family members, partners, friends, and other non-clinical supporters. You can find support options here.