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.

Here is a simple crisis plan you can use (pdf).

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

The information on this page may be helpful to you even if you do not think things have reached a crisis for you, to help you avoid it getting there.

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.

Know that self-care looks different for different people, and your self-care needs can change moment to moment. The focus is on you! The only self-care rules you have to follow are:

1. It works for you right now
2. It is not harmful to someone else

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

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? Here are some ideas…

• I’m feeling overwhelmed right now, can we meet up?
• I’m having a rough time, can you help me distract myself for a bit?
• I’ve been feeling really low lately, would you be up for talking?

Peer support can be a great option if you think it would be helpful to talk to someone who has had their own journey with mental health and “gets it.” 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 or are worried about a crisis someone else is experiencing.

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

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
• Cambridge Community Assistance Response & Engagement (CARE) Team
  Call 617-349-7200
  Monday, 8:30 am to 8 pm
  Tuesday through Thursday, 8:30 am to 5 pm
  Friday, 8:30 am to 12 pm
• Cambridge HEART
  Call 617-902-0102
  Tuesdays & Thursdays,10 am to 4 pm
• Lynn Calm Team
  Call 781-905-2256
  Monday, 8:30 am to 4:30 pm
  Tuesday through Friday, 8:30 am to 8 pm
  Saturday & Sunday, 10 am to 8 pm
• Northampton Department of Community Care
  Call or text 877-322-0413
  Monday through Friday, 8:30 am to 4 pm

Download this list (pdf)

Peer-led crisis programs offer short-term support – a few hours to a few days – in a home-like environment. They 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 their own experience with mental health symptoms, mental health diagnosis, or 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
• Anemoni LBGTQ+ Peer Respite in Holyoke and mobile
  hosted by the Wildflower Alliance
• Juniper in Bellingham 
  hosted by Kiva Centers
• Karaya in Worcester
  hosted by Kiva Centers
• La Paz in Dudley
  hosted by Kiva Centers
• Mobile peer respite at Kiva Centers
• The Living Room at Advocates in Framingham
  hosted by Advocates, Inc
• The Living Room at BHN in Springfield
  hosted by Behavioral Health Network

Download this list (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, like an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP), your mental health provider can also help you set up that care.

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 can offer you 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

Download this list (pdf)

You can use the Substance Use Helpline for help finding other substance use related and addiction treatment and resources:

Massachusetts Substance Use Helpline
1-800-327-5050

Mobile Crisis Intervention (MCI) teams are based at local Community Behavioral Health Centers (CBHCs) and are staffed by mental health clinicians. 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 an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP), 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)

You may find it helpful to participate in a more intensive program, like an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP). Participating in an IOP or PHP may help you avoid psychiatric hospitalization.

Know that you may need a referral to participate in an intensive program – your mental health provider or the MCI team may be able to provide this.

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, a mental health clinician 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.

You may decide that acute psychiatric inpatient care is the right step for you during a mental health crisis, or someone else may make this decision for you in certain circumstances. You may need a referral or medical assessment to get inpatient care. These may be completed by MCI staff or in an emergency department.

The focus of inpatient care is on stabilizing symptoms, and you may be offered new medication and have the option to attend daily groups with other patients. Know that your ability to make decisions about your care may be limited, while you are in the hospital, under certain conditions. You can learn more about your rights during inpatient care at the below resource.

Inpatient Rights

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.

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. 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. Try to manage your own emotions and avoid over-reacting.
• Keep the focus on them. Notice if you are centering your own experience and gently shift back to supporting theirs.
• Listen without judgment. Offer to listen, then really listen. Avoid making assumptions about their experience. If you don’t understand something, gently ask what they mean. Try to validate what they are feeling, without minimizing it.
• Respect if they don’t want to talk. It can be hard to open up about what you’re experiencing. Sometimes just sitting quietly together can be comforting.
• 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. Instead try asking the person what would be helpful, then do that.
• Encourage self-care and taking care of basic needs. You can ask simple questions, like whether eating, drinking water, or resting would help.
• Admit when you don’t know what to say. It’s okay to just spend time with someone and be present.
• Share your boundaries. It’s okay to be upfront about any limits to the support you can give.
• If the person you’re supporting is perceiving things that you do not, it’s 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 do not 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.
• 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.
• 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 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.
• Using the local Mobile Crisis Intervention (MCI) team. Mobile Crisis Intervention (MCI) teams are based at local Community Behavioral Health Centers (CBHCs) and are staffed by mental health clinicians. 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.
• Participating in more intensive care, like an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP). Participating in an IOP or PHP may help the person you are supporting avoid psychiatric hospitalization.
• 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.
• Getting care in a psychiatric unit or hospital, is something the person you are supporting may decide is the right step, or you may make this decision for them. The focus of inpatient care is on stabilizing symptoms. Know that forcing someone to get inpatient care may be a traumatic experience for them.
• 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.

Self-harm means hurting yourself in an intentional way. It is sometimes called self-injury, self-inflicted violence, or self-mutilation. People use self-harm for many reasons, including:

• to distract from or relieve emotional pain
• to express emotional pain in a visible way
• to feel a sense of control
• to punish oneself
• to feel more physically present
• to help oneself mentally check out
• to avoid hurting oneself in a more harmful way

It can be scary when someone you know uses self-harm. It may be helpful to think about self-harm as an attempt to manage difficult feelings or situations. Self-harm can be an effective coping tool for people, so expecting someone to simply stop using self-harm is often not realistic. Here are some strategies that maybe helpful for the person you are supporting:

• Finding ways to reduce the harm, when using self-harm. For example, a harm reduction approach for people who cut themselves could include having bandages and ointment on-hand.
• Substituting another action for the self-harm. For example, someone who hits themselves could find punching pillow or punching bag to be a good substitution.
• Distracting oneself when thinking about self-harm. For example, doing a craft activity or going for a bike ride may be a good distraction for someone.
• Finding ways to explore and move past the underlying thoughts and feelings that lead to self-harm. Good self-care, taking care of one’s physical wellness, and getting support though friends and family, peer supporters, or mental health providers may be part of the journey.

Deciding what is helpful for moving past self-harm should always be the decision of the person who is using self-harm. 

Some things that generally are not helpful:

• presuming that you know why someone uses self-harm
• expecting that someone will (or can or wants to) immediately stop using self-harm
• making self-harm the focus of your relationship with the person
• body checks to ensure that someone is not using self-harm *
• safety contracts where someone pledges to not use self-harm or there are consequences when they do use it (unless the person has identified this as being helpful and they have requested it)
• coercing or forcing someone to engage in treatment
• anything the person who is using self-harm thinks is not helpful

People often have a strong reaction to someone else’s self-harm. It can be hard to know what to say or how to say it. When someone you know maybe using self-harm, acknowledging what you noticed in a direct but gentle way and offering your support can be a good place to start. For example, you could say “I noticed your [bandage, scar, wound]. I’m here to talk, if you would like.”

If they don’t want to talk, leave it at that. Self-harm is a very personal experience, and some people will not feel comfortable talking about it. Respect that.

If they do want to talk, you can ask open-ended questions:

• what would be helpful right now?
• what can I do to support you?

It’s important to think about your own limits and needs while supporting someone else. Make sure you’re taking care of your own basic needs, like eating and sleeping. You may also want to try some self-care activities like:

• going for a walk
• playing a game
• listening to music
• doing yoga or meditation
• cuddling your pet
• hitting a punching bag
• going to a support group
• any other thing you find restorative!

When you’re supporting someone who uses self-harm, you may feel the need to get your own support. That’s understandable! Do try to use discretion and avoid sharing details that the person you are supporting has shared with you, especially if you are getting support from someone who knows the person.

For many people that think about suicide, talking about their thoughts can help them move past them. It can be hard to know what to say or do. Here are some ideas…

Some things you can say when someone tells you they are thinking about suicide:

• Do you want to talk more about it?
• Did something happen that made you feel this way?
• Have you felt this way before?
• What has worked in the past?
• Have you been able to share this with anyone else?
• What do you need to get through this?
• What would be helpful right now?
• I’m not sure what to say, but I can sit and listen.

Some things you can offer when someone tells you they are thinking about suicide:

• sit and listen
• help the person think through what would be helpful
• honor their preferences about what is and is not helpful
• being clear about your own limits and needs

Some things you should try not to do when someone tells you they are thinking about suicide:

• make it about yourself
• take charge
• try to assess or “fix” the person
• say things that can feel invalidating or minimizing of their experience
• say the person should feel guilt or shame about their feelings
• make promises that you cannot keep
• make decisions for them or go behind their back

Supporting someone who is experiencing a crisis can take a lot of energy. It’s important to also think about your own needs. You can find ideas for self-care above.

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.