Navigating a Mental Health Crisis

It can be frightening when you or a loved one is experiencing a mental health crisis. You may not know what to do. Below are some ideas for navigating a crisis that you or someone you support is experiencing.

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If You Are Experiencing 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 can help ensure that your preferences are honored during the crisis, and may also help interrupt things before they get to a crisis level.

Resources for Wellness & Crisis Planning

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. 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 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, or chat service. Their operators are trained to provide support and resources to people who are experiencing a crisis. You can call using a Voice Over Internet (VOIP) service or chat while using a virtual private network if you are worried about privacy.

Crisis Call, Text, and Chat Services

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. If you feel like you need more intensive support, your mental health provider can also help you set up that care.

Peer-led crisis programs are led by people who have had experiences that are typically labeled as mental health symptoms themselves. They provide support for people dealing with a crisis, or to help prevent times of crisis.

  • Afiya in Northampton
    Afiya is a peer respite 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.
  • Karaya in Worcester (opening soon)
    Karaya is a peer respite for people who is experiencing distress and feels they would benefit from being in a short-term, peer-supported environment. Karaya is hosted by the Central Mass Recovery Learning Community.
  • Peer to Peer Program in Quincy
    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
    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 Greenfield
    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 Clinical & Support Options.
  • The Living Room in Springfield
    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.

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 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 all ESPs accept MassHealth and Medicare (including OneCare and Senior Care Options plans), and also support people without health insurance. Many ESPs also contract with commercial insurance plans. You can contact your local ESP to confirm what insurance coverage they can accept.

ESPs often cannot 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 a substance use urgent care clinic.

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 assess you 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  for you may be limited.

If Someone You Support Is Experiencing A Mental Health Crisis

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 what they mean.
  • Offer the person validation with what they’re feeling, and try not to minimize it. If they perceive things that you do not, it’s generally not helpful to say that they’re wrong (unless the person has indicated that reality-checking with you is something they do 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, 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 for them and making decisions on their behalf. 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 the support that will work for them.

Having thoughts about suicide is common, but many people who experience thoughts about suicide (including people getting ongoing mental health treatment) don’t have someone they can trust to talk to about the thoughts. When people do ask for help, coerced or forced treatment is often the response. This response can also make it harder for people to reach out again, in the future. Yet for many people, talking about their thoughts can help them move past them.

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. 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:
  • 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 try to “fix” the person
  • tell the person they have a lot to live for
  • 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

Self-harm means hurting yourself in an intentional way. Self-harm is a common experience. 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 intense emotional pain
  • to feel a sense of control
  • to express emotional pain in a visible way
  • to punish themselves

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 for someone, 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 likely 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?” or “is there anything that I can do?”
  • Know that self-harm can be an effective coping tool, and they may not want to simply stop using it. Thinking about “harm reduction” may be more useful. Harm reduction is simply finding ways to reduce risk. For example, a harm reduction approach for people who cut themselves could include having bandages and ointment at hand when the self-harm happens to help reduce the risk for infection. To bring up harm reduction with someone, you could say… “I get that this may be helpful to you, but I’m worried about [specific risk]. Is that something your worried about too? Would it be helpful to think through some ways to avoid that?” 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, or chat service – these are available to provide support and resources 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-led crisis program – 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 or Using Urgent Care – 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 and urgent care options 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. Know that the care options that can be offered in the emergency room are often more limited than what an ESP can offer, and the ability to choose the care that they think will work best for them may be limited.

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 family support options welcome all family members, partners, friends, and other non-clinical supporters. You can find support options here: https://namimass.org/family-support/.