Navigating a Mental Health Crisis

If you have experienced a mental health crisis in the past, you may want to plan ahead in case a crisis happens again. Planning ahead helps ensure that your preferences are honored during the crisis, and can sometimes help interrupt things before they get to a crisis level.

Resources for Crisis Planning

• Wellness Recovery Action Plan (opens in a new window)
  Wellness Recovery Action Plan (WRAP) is a wellness process that anyone can use. It helps you figure out what you need to do to stay well, and how to plan for a crisis.
• Madness & Oppression: Paths to Personal Transformation & Collective Liberation (opens in a new window)
  This guide, examines the intersections of oppression and mental health struggles, and takes you through the process of creating your own personal wellness document.
• Making a Self Care Plan (opens in a new window)
  Tips for making a simple self care plan.
• A New Kind of Safety Plan (opens in a new window)
  A simple safety plan for recording your personal crisis warning signs, what you can do to stay safe, and who can help during this time.
• Navigating Crisis (opens in a new window)
  Key things to think about when you are dealing with mental health crisis.
• Psychiatric Advance Directives: Forms to Prepare (opens in a new window)
  Psychiatric Advance Directives (PADs) are documents that you can use to specify your preferences for mental health care during times you are not able to give consent.
• Staying Out of the Hospital: a Guide to Surviving Psychosis (opens in a new window)
  This guide offers support and guidance or people who are going through a mental health crisis from a non-judgemental and holistic perspective.

Need help finding tools and supports to include in your wellness or crisis plan? Reach out to the COMPASS Helpline! We provide information and resources to help people navigate the  mental health system and problem solve in difficult circumstances.

Learn more about the NAMI Mass COMPASS Helpline

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 well 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 the last time you ate or slept was. Sometimes we neglect basic needs when we are not doing well, and that can worsen what we are experiencing.

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

You can try doing something that makes you feel good or that distracts you from what you’re experiencing.

Need some ideas?

• Get some self care ideas (pdf – opens in a new window)
• Read 21 Free (and Inexpensive) Self Care Ideas (opens in a new window)
• Check out 30 Simple Self-Care Ideas To Improve Your Mental Health (opens in a new window)
• See various strategies for coping from the Hearing Voices Network (opens in a new window)

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.

If you think that you can’t manage this alone, reach out to a friend, family member, peer supporter, 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 (opens in a new window) for ideas.

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, resources, and referrals to people who are experiencing a crisis.

Crisis Call, Text, and Chat Services

National Suicide Prevention Lifeline (opens in a new window)
1-800-273-8255
available 24/7, talk or chat online

Crisis Text Line (opens in a new window)
text HOME to 741741
available 24/7, text only

Samaritans Statewide Helpline (opens in a new window)
1-877-870-4673
available 24/7, talk or text

Call 2 Talk (opens in a new window)
508-532-2255
available 24/7, talk or text

Get a list of additional crisis call, text, and chat services (pdf – opens in a new window)

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 support. Many mental health practices offer urgent care for their patients, either with the patient’s provider or an on-call provider.

Peer-based crisis alternative programs are a support option for people dealing with a crisis, or to help prevent times of crisis.

• Afiya in Northampton (opens in a new window)
  Afiya is a peer respite program for people who is experiencing distress and feels they would benefit from being in a short-term, peer-supported environment. Afiya is hosted by the Western Mass Recovery Learning Community.
• Peer to Peer Program in Quincy (opens in a new window)
  Aspire Health Alliance hosts the Peer to Peer Program in Quincy. Housed within their crisis team, it offers short-term support to people in times of crisis as well as after.
• The Living Room in Framingham (opens in a new window)
  The Living Room is a short-term peer-run diversion program that provides support to people in times of crisis. The Living Room in Framingham is hosted by Advocates, Inc..
• The Living Room in Springfield (opens in a new window)
  The Living Room is a short-term peer-run diversion program that provides support to people in times of crisis. The Living Room in Springfield is hosted by Behavioral Health Network.
• The Living Room in Greenfield (opens in a new window)
  The Living Room is a short-term peer-run diversion program that provides support to people in times of crisis. The Living Room in Greenfield is hosted by Behavioral Health Network.

If you you need to speak with a mental health provider urgently about what you are experiencing, you can call your local Emergency Services Program (ESP). ESPs – often called crisis teams – 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 supports they need to manage the crisis.

ESP services are available 24 hours a day, 7 days a week, 365 days a year. You can find the ESP serving your area, by calling 1-877-382-1609 and entering your zip code. You can also check out this list of ESPs by location (pdf – opens in a new window).

Note that ESPs may not support people who have recently used substances. If you need urgent substance-related care and cannot get support through your local ESP, you can try the following:

• Boston Medical Center’s Faster Paths to Treatment in Boston (opens in a new window)
• Community Healthlink’s Behavioral Health and Addiction Urgent Care in Worcester (opens in a new window)
• SSTAR’s Open Access Center in Fall River (opens in a new window)
• your local emergency room if it is a life-threatening emergency
• Mass Substance Use Helpline (opens in a new window) for help finding other substance use related treatment and resources

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 room.

Like Emergency Service Programs (ESPs), emergency room providers will give you an assessment to help determine next steps. Know that the care options that can be offered in the emergency room are often more limited than what an ESP can offer, and your ability to choose the care that you think will work best 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 ensure that their preferences are honored during the crisis, and can sometimes help interrupt things before they get to a crisis level.

Find resources for wellness and crisis planning here: https://namimass.org/in-a-crisis/#1573739874479-c5f577f9-3085.

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 well 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:

• Try to keep calm and avoid over-reacting!
• Offer to listen to the person, then listen without judgment. Try to avoid making assumptions about their experience. If you don’t understand something they said, gently ask for clarification. For example, you can say, what does it mean when you say…
• Offer the person validation with what they’re feeling, and try not to minimize it. If they perceive things that you do not or believe things that are not likely, it’s not helpful to say that they’re wrong. Understand that the experience is real for them and validate the pain, anger, fear, etc. that they are feeling.
• Understand that your role is to support the person and not to “fix” them. Try to avoid deciding what’s best and making decisions for them. Instead ask the person what would be helpful, then do that.
• Some people will find talking to someone will help them move through the crisis. Other people may need more support. You can offer to help them find support that will work for them.

Having thoughts about suicide is common. When someone is thinking about ending their life, they may be:

• dealing with a tough situation
• coping with an uncomfortable feeling
• experiencing an unbearable pain
• feeling stuck, overwhelmed, disconnected, desperate, or rejected

Getting Support

Many people with thoughts about suicide do not have someone they can talk to about the thoughts. This can include people who get ongoing mental health treatment. Often when people ask for help with thoughts about suicide they are involuntarily hospitalized. Being in the hospital is not always helpful to people who are thinking about suicide, and can even be damaging. This response can also make it harder for people to reach out again in the future.

Yet for many people, talking about what they’re thinking can help them move past the thoughts. When someone tells you they are thinking about suicide, they almost always are looking for your support to deal with and get past those thoughts. By being willing to listen to them, you can help them with their healing.

What You Can Say and Do

It can be hard to know what to say or do when someone tells you they are thinking about suicide. 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:

• to sit and listen
• to help the person explore what would be helpful
• to 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:

• take charge
• assess or fix” the person
• tell the person they have a lot to live for (well meaning but can feel invalidating)
• 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

Self harm means hurting yourself in an intentional way. Self harm is common. It can include things like cutting, burning, or hitting oneself, driving in a way that is intentionally reckless, and ingesting harmful substances. People use self harm to for many reasons:

• to manage difficult emotions
• to relieve intensive emotional pain
• to feel a sense of control
• to express emotional pain in a visible way
• to punish themselves

Responding to Self Harm

It can be scary when someone you know uses self harm. People often have a strong negative reaction to someone else’s self harm. They may think that it is something that needs to be stopped right away. But responding to someone who self harms in a shame-based way can be damaging. Self harm can be an effective coping technique, and simply stopping it can make the feelings the person is dealing with more intense.

Instead try responding to the person with compassion. Know that the pain they are experiencing is intense. Here are some ideas for how to respond:

• You can acknowledge the self harm in a direct but gentle way. For example, you could say… I noticed your [bandage, scar, wound]. I’m here to talk, if that would be helpful.
• 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, try to listen without judgment of what they are feeling or how they are coping with it. You could ask… did something happen? have you done this before? is there anything that I can do?

Harm Reduction

Self harm can be an effective coping tool, so people may not want to simply stop. Harm reduction techniques may be more useful. Harm reduction is finding ways to reduce the risk and make the self harm safer. For example, a harm reduction approach for people who cut themselves could include having bandages and ointment at hand when the self harm happens.

When talking to someone about self harm, you can say something like… I get that this is helpful to you. Are you being careful when you do it? Deciding to reduce harm, and how to do so, should always be the decision of the person who is using self harm unless they ask for your help.

Sometimes the person you are supporting will want other kinds of support. You can help them figure out what would be helpful. Here are some potential support options:

• Using a crisis call/text/chat service – these are available to provide support, resources, and referrals to people who are experiencing a crisis. Find a list of services here: https://namimass.org/in-a-crisis/#1553104865282-03543320-7f37.
• 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 an on-call provider.
• Use a peer-based crisis alternative – these are a support option for people dealing with a crisis, or to help prevent times of crisis. You can learn more here: https://namimass.org/in-a-crisis/#1573750439708-5a0c55fe-4da2.
• Calling the local Emergency Services Program – a good option if the person wants to speak with a mental health provider urgently about what you are experiencing. You can read more about ESPs here: https://namimass.org/in-a-crisis/#1553104929813-69f04621-faf8.
• Going to the local Emergency Room – when other options are not available or the crisis involves a medical emergency

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: https://namimass.org/in-a-crisis/#1553104810357-c5e3d337-a2db.

You can also try family support, if you think that would be helpful – know that most options also welcome friends and other supporters. You can find support options here: https://namimass.org/family-support/.