• ASK who in the department is trained to deal with people who are having a mental health crisis. For example: “I am calling about an emergency involving mental illness. Do you have someone assigned to handle mental health emergencies?”
• MAKE IT CLEAR it clearthat you are calling about someone having a psychiatric crisis. For example: “My daughter has bipolar disorder, she is not taking her medication and she is manic.”
• DESCRIBE the behavior you are seeing that most closely matches the laws in your state that are used to hospitalize someone for emergency psychiatric care or to initiate civil commitment proceedings. For example, don’t say, “My son is a danger to self,” say “My son says he is going to blow his brains out and I know he has a gun in his car trunk,” or “My daughter is setting fire to wastebaskets all over the house.”
• EXPLAIN why you cannot handle the situation yourself. For example: “I am frightened he will hurt me,” or “She is throwing things at the walls and I cannot get her into a car.”
• BE VERY CLEAR that you are seeking involuntary psychiatric hospitalization and NOT arrest.

Print a copy of our psychiatric crisis guidelines with your list of essential telephone numbers. Remember to take your CARE Kit if you follow emergency transport to the hospital or police station. 
IF THERE IS A SUICIDE THREAT: Remember: It is a myth that people who threaten to kill themselves don’t do it.

• ASSUME that any suicide threat is serious and treat it as a danger to the person’s life. A previous suicide attempt increases the likelihood that the person will act on the threat.
• ASK the person in a calm, quiet setting whether he/she is thinking about suicide. Your questions can be indirect (“Do you ever think you should never have been born?”) or direct (“Do you feel like you want to die?”)
• FOLLOW UP if the answer to these general questions is “Yes” and ask about specific suicide plans. When does the person plan to commit suicide? How? Has the person already acquired the means, e.g., pills, gun, etc.
• DETERMINE the imminence of the danger based on the answers to these questions. A college freshman who describes a suicide plan for graduation day in four years is probably not in danger. A college senior who is graduating the next day is. Act accordingly.
• CONTACT the person’s mental health or medical providers and repeat exactly what the person has told you.
• HIDE all vehicle keys and any means that could be used for self-harm, e.g., medications (including over-the-counter drugs), knives including kitchen knives, guns, ropes.
• KEEP the person sober. Suicide completers have high rates of positive blood alcohol. Intoxicated people are more likely to attempt suicide using more lethal methods. Be aware that the combination of alcohol and Tylenol can be lethal. Be sure there is no Tylenol available if the person is drinking.
• DO YOUR BEST to persuade the person to get help voluntarily. Dial the hot-line number, drive to the clinic, take a taxi to the ER. Do whatever is necessary to make getting help easy.

CALL 911 if the suicide attempt appears likely.  
Click here for a list of suicide hot-lines.
Print a copy of our suicide crisis guidelines with your list of essential telephone numbers.

IF THERE IS A THREAT OF ASSAULT:

• DON’T underestimate the risk. People who are acutely psychotic, especially if also delusional and abusing alcohol or street drugs, are not predictable and are capable of extreme violence
• DISCUSS the situation with the person’s case manager, social worker and/or psychiatrist. Make sure they are aware of the person’s threatening or assaultive behavior. If possible, put your concerns in writing to them and cc the message to others in a position of responsibility: Written notification is much more difficult to ignore.
• SAFE-PROOF your home. Have a room to which you can retreat and be safe if needed. It should have a secure lock and a telephone. Do not allow firearms in the house.
• CLEARLY SPELL OUT the consequences for the person if he/she becomes assaultive (e.g., may no longer live at home). Be prepared to carry out these consequences.
• MINIMIZE alcohol or street drug use in whatever ways are possible. Substance abuse is often a trigger for assaultive behavior.
• IF threatened by someone with manic-depressive illness (bipolar disorder), remain calm, keep conversation to a minimum and exit the situation.
• IF threatened by someone with schizophrenia, stay calm, remain physically distant (give the person lots of space), avoid direct eye contact, sympathize, try to find something on which you both agree.
• DO NOT ALLOW yourself to become trapped. Always remain physically between the person and the open door.
• DO NOT HESITATE to call the police.

Print a copy of our assaultive crisis guidelines with your list of essential telephone numbers.

IN ANY CRISIS: Your goal in an emergency is to stabilize the situation and get the person to professional help as quickly as possible.

• Do not try to manage the situation alone – Sometimes just having another party present or on the phone with your loved one will defuse a situation.
• Start at the top of your Emergency Contacts list and work your way down – If it is an evening or weekend and you cannot reach providers or agencies, call the most appropriate hot-line.
• Speak to your loved one in a calm, quiet voice – If it seems he/she isn’t listening or can’t hear you, it is possible that auditory hallucinations (“voices”) may be interfering. Don’t shout; raising your voice won’t help and may escalate tensions.
• Keep instructions and explanations simple and clear – Say, “We’re going to the car now,” not, “After we get in the car, we’ll drive to your doctor’s office so she can examine you.”
• Respond to delusions by talking about the person’s feelings, not about the delusions – Say, “This must be frightening,” not “You shouldn’t be frightened – nobody’s going to hurt you.”
• Don’t stare – Direct eye contact may be perceived as confrontational or threatening.
• Don’t touch unless absolutely necessary – Touch may be perceived as a threat and trigger a violent reaction.
• Don’t stand over the person – If the person is seated, seat yourself to avoid being perceived as trying to control or intimidate.
• Don’t give multiple choices or ask multi-part questions – Choices will increase confusion. Say, “Would you like me to call your psychiatrist?” not “Would you rather I called your psychiatrist or your therapist?”
• Don’t threaten or criticize – Acute mental illness is a medical emergency. Suggesting that the person has chosen to be in this condition won’t help and may escalate tension.
• Don’t argue with others on the scene – Conduct all discussion of the situation quietly and out of the person’s hearing.
• Don’t whisper, joke or laugh – This may increase agitation and/or trigger paranoia.