- Natasha J. Thomas, MD
Supporting a Loved One Through a Mental Health Crisis
Updated: May 12, 2021
Each year in America, nearly 20% of adults experience a mental illness. According to the U.S. Surgeon General, 20% of our children also experience mental illness – every year. Psychological, psychiatric and emotional concerns are all around us. Statistically speaking, if you have at least 5 adults in your family, and 5 children, you know at least two affected people. Many times, mental health concerns go undiagnosed. And only 40% of those diagnosed seek treatment.
All these statistics boil down to one simple fact: you will probably have to help someone you love cope with mental health challenges at some point in your life. Knowing what to do is obviously important, for your loved one and for yourself. Many people seem willing to help when the issue is quiet or subtle. But what happens when the issue becomes intense, full-force and scary? If someone came to you today saying, “I don’t want to be here anymore. I’m not going to hurt myself, I just don’t want to be alive,” what would you do?
Below I’ve listed several tips on helping your friend or family member through a mental health crisis, and 8 websites that can provide additional resources. Since part of life is helping others, let’s review how we can do it well.
Know the Signs
When a person is beginning to decline into a mental health crisis, there are usually very clear signs. Some people have said, though, that they were shocked when a loved one took their own lives unexpectedly. So, how can you tell? For me, one of the most concerning signs is when a person loses the ability to sleep normally. The mind just struggles terribly when fatigued. And neurochemical processes change in the sleep-deprived person. If you see a drastic shift in a person’s ability to sleep, pay close attention. Also, look out for these signs:
Sadness and inability to find joy in things
Loss of motivation coupled with statements that indicate a loss of life purpose or feelings of futility
Irritability, agitation, new-onset aggression
Guilt that is unwarranted
Severe panic, circular thinking, unnecessary and excessive worry
Irrational thinking or mood swings that are not triggered
Shifts in energy (too high or too low)
Changes in the ability to concentrate or focus on a topic
Changes in food-related behaviors (some people won’t eat, some binge, some hide food)
Odd or erratic behaviors (suddenly driving to another state, showering with clothes on, talking to inanimate objects, etc.)
Strange thoughts (being followed, spied on, having special powers, suddenly communicating with “aliens”, etc.)
Changes in speech pattern or amount of speech produced (some become very quiet, others talk non-stop)
Signs of hallucinations (talking to no one in particular, or an identified person or power that you don't see). If you know your loved one to be very religious or spiritual but they are suddenly praying compulsively, talking to demons/spirits or participating in practices that don't align with their known faith, take note.
Sudden changes in level of physical activity or facial expression
When hospitalization is necessary
Sometimes, a person's symptoms can be "caught" before they decline to the point that hospitalization is necessary. This may be the case if they have an established relationship with a psychiatrist and can get in for an urgent session.
However, if a person is in an acute mental health crisis, you need to think twice before trying to care for them on your own. If your family member seems to need 24-hour supervision or can't be left alone due to safety concerns, it's time for them to go to the hospital. No, hospitals are not glorious places. I've heard many complaints about the negative aspects of psychiatric inpatient units. However, for stabilization, safety and protection of life, they are at times necessary.
You should never be in the position of trying to figure out if your loved one may be a danger to themselves or others on your own. Take them to a hospital or mental health professional in your area (in a life or death crisis, go to the hospital). If they won't seek treatment, you may have to call a crisis unit to your home, or even call the police. Do not feel guilty if you have to take extreme measures. Sometimes, love looks like this.
Attend their appointments
If your family member needs hospitalization and is willing to go, that is good news. If they will allow you to participate in their care, please do. Jot down notes about your loved one's mental health history - as they may not be in the best state to remember medical details.
Try to make a list of the following:
Outpatient psychiatrist or counselor's name
Past hospitalizations for psychiatric reasons
Current or past psychiatric medications (and reactions)
Recent symptoms (changes in behavior, patterns, speech, sleep, thinking and appetite)
What you know of past episodes, if any
When they first get to the hospital, they will be assessed by a social worker, counselor or psychiatrist. Generally, they will be in a secured holding area and you may not be allowed in the examining room. However, you should be able to hand them your notes. Astute assessors will take the time to speak to family that is present. If they do, relax and try to tell them how your loved one has seemed over the past weeks to days.
Encourage them to give you permission (by signing Release of Information forms) to speak to their treatment team. Since hospital stays are about 3-5 days on average, your loved one will need extensive ongoing care. Participate in "discharge planning" with their hospital treatment team if allowed. Discharge planning should consist of follow-up appointments, community resources, tips to avoid relapse and other matters. Some hospitals have a "family meeting" before a patient is released. If that is offered, you should attend. Also, be sure you know who they will be seeing for psychiatric care after they leave the hospital. They should be scheduled with a psychiatrist, and maybe even a counselor, before they are released. Advocate for them to have all follow-up appointments in place before they leave. Try to understand their medication regimen, how and when they should take it and side effects. You may have to temporarily help them stay consistent with medication.
Once they start seeing an outpatient psychiatrist, see if they'll let you join in the first session. Also, ask if they will sign a Release of Information so their new doctor can talk with you about their progress. Use boundaries. This should not be an attempt to pry into issues that don't impact your loved one's safety, impose your personal beliefs on their way of living or to control them. However, the doctor may need to talk to you at times to be sure the way they seem in session fits with how they're doing in real life. Be available to help.
Please, please, please do not schedule appointments for your teenage children and fail to attend their sessions - especially not the first one. Even if they are 16 or 17 and can drive alone, they need you there for moral support. Doctors need you there for accurate medical history.
If your spouse is very ill and is asking you to join them, please do - even if you feel it's not necessary or it's uncomfortable.
Understand privacy laws
Even though it's frustrating at times, we have national laws regulating medical confidentiality. The information your loved one shares with their mental health provider is privileged and cannot be shared without permission in most cases. The Health Insurance Portability and Accountability Act (HIPAA, 1996) dictates that your loved one will have to sign a document for you to be able to speak to their providers. This form is usually called a Release of Information form. People have the option of releasing only certain parts of their medical history. For further information, read here.
In children and adolescents, the rules are different. However, many providers doing psychotherapy will only disclose information needed to maintain the child's safety. This is because if your child feels everything they share with their doctor or counselor is just going to be repeated to you, they will not be able to be honest in their sessions.
Don't forget the basics
When someone is going through a crisis, it is important to try and keep the basic tenets of wellness intact. Encourage your loved one to:
Eat regular meals (or snacks if their appetite is low)
Get out of bed in the morning and not hang around in their bedroom
Get dressed and avoid spending the day in pajamas
Get some physical activity
Offer them love in the form they are able to receive. Sometimes, people may not want to be touched or engage in affection and that's ok. Let them know you love them, don't judge them, and are there to support them. If they find strength in prayer, family, certain shows, etc., keep those people and things around them to the degree they can tolerate.
Also, try to maintain normalcy and routine where you can. Don't miss opportunities to share a little humor with them.
Take care of yourself
Helping someone in any kind of crisis can be challenging and exhausting. Make sure that you continue to tend to your own mental wellness as you're supporting your loved one. You need good sleep, nutrition, physical activity and down time. You also need time away from crisis management. It may feel selfish or irresponsible but take some time just for yourself. You will not be a good support if you're worn out.
Do not allow your loved one to be abusive to you. Harsh words spoken to you are likely out of frustration or confusion more than anything. But most times, I have seen that even at our most ill, as people we know when we're being mean to someone. Gently set clear boundaries and disengage for the short-term if you feel your loved one is intentionally being hurtful.
A Special Word: When Crisis Becomes Chronic
For some mental illnesses, people may go through many episodes and relapses. This is especially true for issues like schizophrenia and bipolar-spectrum disorders, and can happen with depression as well. If your family member begins to have repeated, revolving-door psychiatric hospitalizations due to refusing to participate in care or remain on medication, you may have to seek guardianship of them. It is a legal process that gives you the ability to help them stay adherent to an effective treatment plan. Go to https://www.nami.org/ to learn about guardianship and alternatives based on your state law.
Whether it’s to support your loved one through depression, anxiety, bipolar disorder, psychotic episodes, PTSD, grief, postpartum mental health issues or others, there are resources! The links below may be a helpful starting place.
Please share your thoughts in our comment section. If you have questions, or experience that will help others, please let us know!