How to Navigate a Mental Health Emergency + What to Expect

Navigating a mental health emergency can be a daunting experience for families, often leaving them feeling stressed and overwhelmed. Understanding how to effectively handle such situations and knowing what to expect can make a significant difference in providing the right support. From recognizing the signs of a crisis to knowing how to communicate with emergency responders, families play a crucial role in ensuring their loved ones receive the care they need. Today, we will be discussing practical strategies for families dealing with a mental health crisis. We will cover important steps to take, ways to advocate for your loved ones, and what to expect throughout the process. Our conversation today aims to clarify how emergency mental health situations are managed and provide insight on how to prepare for such scenarios in advance.

Need help? If you or someone close to you is experiencing a crisis due to a mental health challenge and may be a danger to themselves or others, you should call 988 or 911. Always?call 911 first?if you or someone you love is experiencing a life-threatening medical emergency or may be a danger to someone else. If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the 988 Lifeline network is available 24/7 across the United States.

In the Event of Emergency

Know Your Resources

Understanding what resources are available before a mental health crisis occurs can significantly mitigate confusion during the crisis and ease stress for family members and your loved one who needs help.

• CAT- Centralized Assessment Team provides assessment and evaluation of individuals experiencing psychiatric emergencies including threats of harm to self, others, or gravely disabled ?? 866-830-6011
• Didi Hirsch Crisis Hotline provides 24-hour, immediate, confidential over-thephone suicide prevention services to anyone who is in crisis or experiencing suicidal thoughts. ?? 877-727-4747
• NAMI Warmline provides telephone-based, non-crisis support for anyone struggling with mental health and/or substance abuse issues. ?? 877-910-9276 or 714-991-6412
• The Office of Consumer and Family Affairs provides educational information and support for consumers and family members to understand the mental health system better. ?? 714-834-5917
• Information and referral by telephone and internet-based live chat to link participants to County Behavioral Health Services. Available Monday through Friday, 8am to 6pm. ?? 855-OCLINKS or www.ochealthinfo.com/oclinks
• The National Alliance on Mental Health (NAMI) has a fantastic guide, Navigating a Mental Health Crisis: A Nami resource guide for those experiencing a mental health emergency . This is a valuable tool for family members looking to understand and navigate mental health emergencies.

What To Do in a Mental Health Crisis

When someone is experiencing a mental health crisis, it can be a challenging and frightening situation for friends and family. Recognizing the signs and taking the right steps to help is important. If you believe that you or someone else is in or approaching a crisis, seeking help is essential.

Assess the urgency of the situation based on the following questions:

• Is the person in danger of harming themselves, others, or property?
• Do you require immediate assistance?
• Do you have time to seek guidance and support from a mental health professional over the phone?

It can be difficult for a person in crisis to communicate their thoughts and emotions clearly, so it's crucial to approach the situation with empathy, stay calm, and try to de-escalate the crisis. If the initial steps don't help, seeking outside assistance and resources is important.

Techniques That May Help De-Escalate a Crisis

NAMI recommends these techniques when trying to de-escalate a crisis:

If you're unable to de-escalate the crisis, seek help from mental health professionals who can assess the situation and determine the level of intervention required.

If you don’t believe there is an immediate danger, consider reaching out to a psychiatrist, clinic nurse, therapist, case manager, or family physician familiar with the person’s history. They can help assess the situation and provide advice, including obtaining an appointment or admitting the person to the hospital.

In case of worsening situations, consider contacting your county mental health crisis unit, crisis response team, or similar contacts. If the situation is life-threatening or involves serious property damage, call 911 and request immediate assistance. When you call 911, explain that someone is experiencing a mental health crisis and provide specific details about the emergency. We'll talk about what to expect during the 911 call below.

Should I call 988 or 911?

If you or someone you care about is experiencing emotional distress but isn't in immediate danger, you can now dial 988 to reach the National Suicide Prevention Lifeline. Previously, the Lifeline was reachable at 800-273-8255. This simplified service allows you to call, text, or chat online for confidential support at any time.

988 offers free and confidential emotional support 24/7 for anyone in the United States going through a suicidal crisis or emotional distress. When you dial 988, your call is directed to a local crisis center based on your phone number, ensuring that you receive personalized support from professionals familiar with your community.

Once connected to local crisis support services, trained counselors provide compassionate support and access to local resources for various mental health-related issues, from suicidal thoughts to substance use crises or any other emotional distress. This service is also available for those worried about a loved one’s mental well-being.

While 988 is different from 911, it works with emergency services when necessary. If a caller is in a medical emergency, facing imminent danger, or needs immediate intervention, 988 counselors will coordinate with 911 and inform the caller of this step to ensure their safety.

What should I do before calling 911?

If your loved one is in a mental health crisis, Family Education & Resource Center (FERC) advises being ready to provide the following 6 W's before calling 911.

• Where: Law enforcement needs to know your exact location. Don't assume they can automatically obtain it from your cell phone.
• Who: When seeking help, the dispatcher will ask for the name, age, ethnicity, and description of the person needing assistance. If there are multiple people at the location, it's important to specify who the call is for.
• What: Clearly communicate to the officers that this is a psychiatric emergency and that your loved one is not a criminal. For instance, if your loved one is experiencing auditory hallucinations and actively considering self-harm, inform the dispatcher about these specifics.
• Why: Reiterate that this is a mental health emergency and share any formal diagnosis the person may have.
• When: Provide the time frame of the mental health crisis - whether it occurred recently, is ongoing at the moment, or happened in the past.
• Weapons: Clearly state if weapons are involved in the situation. Informing the responding officers about the presence of weapons may increase the urgency of their response. However, providing accurate information about weapons is crucial. Avoid exaggeration or misinformation, as it could lead to dangerous outcomes.

?? Important Tip: Remember to emphasize to the 911 operator that the situation is a mental health emergency. Ask the 911 operator to send a trained professional who is equip to handle individuals with mental illnesses, such as a Crisis Intervention Training (CIT) officer.

Crisis Intervention Team (CIT) officers receive specialized training to identify and defuse situations involving individuals with mental illness. They are aware that people with mental health issues may need a unique approach and have knowledge of local mental health services that can be mobilized during an emergency. Although CIT officers may not be available in every location, you can ask for one when you dial 911.

The 911 Call : Important Things to Remember

Before you make the call, take a deep breath. Once you're on the line, providing clear, concise information to the 911 dispatcher is important. Remember to be very specific about the behaviors you notice when providing information about a person in a mental health crisis. Focus on recent and current behaviors rather than events from the past. Keep your description brief and direct.

When speaking with the 911 dispatcher, focus on providing tangible details about rather than broad statements.

? Avoid saying phrases like: "My brother is freaking out, I don't know what's wrong with him" or "My brother is behaving strangely."

? Try providing specific details: "My brother is talking to a fictional person who is not present. He barricaded himself in his room two days ago and said the voices told him he wasn't safe. He refuses to come out of his room to use the restroom, shower, or eat."

? It's important to avoid oversimplifying. Phrases like "I don't know what's happening, I need help" or simply saying "Send help" don't fully communicate what's happening to the 911 dispatcher.

? Instead, try saying something like "My brother does not have a criminal history or formal mental health diagnosis. We need help. Can you please send a CIT Team or mental health expert when you respond? This is very out of character, and we really need immediate help from a mental health professional."

By providing additional details, the 911 dispatcher can allocate appropriate support resources for the emergency response.

Remember to report any current psychotic behavior, significant changes in behavior, threats to other people, and increases in manic behaviors or agitation. After dialing 911, be prepared for the potential involvement of both medical/first responders and law enforcement.

I'm not sure what psychotic or manic behavior looks like. Can you give me a few examples of this type of behavior?

This is not an exhaustive list, but here are a few things to keep an eye out for that are warning signs for psychotic or manic behavior. Mania is a state characterized by a period of unusually heightened, extreme fluctuations in mood or emotions, as well as in energy and activity levels.

Psychosis involves disturbances in a person's thoughts and perceptions, making it challenging for them to distinguish between what is real and what isn't. These disturbances can manifest as seeing, hearing, or believing things that are not real, as well as experiencing unusual and persistent thoughts, behaviors, and emotions. Although individual experiences may vary, most people describe psychosis as a frightening and bewildering experience.

What do I do after I call 911?

After reaching out for assistance, take the following steps to prepare for the arrival of the police. Be prepared for the potential involvement of law enforcement and medical first responders.

• Remove any items that could be used as a weapon. Also, remove anything that may confuse the matter or be perceived as a weapon.
• Turn on all the lights in your home to improve visibility.
• Turn off all audio devices to reduce distractions.
• Unlock all of the doors, and keep keys and cell phones with you.
• Contain animals—Relocate animals to a different room to prevent them from interfering with emergency responders or possibly running out of the house. If you're unable to move animals to another room, secure them with a collar and leash and move them to a secluded area in the room or place them in a kennel if possible.
• When the police arrive, try to meet them outside before they interact with your loved one. Brief them on the situation and your loved one's emotional state, and offer helpful suggestions that may work best for your loved one.
• Be direct and open with the police. Do not exaggerate the situation or leave out relevant information. Provide a brief history of your loved one's behavior.
• Give the police a brief information sheet (1-2 pages) that includes a photo of your family member, medical and psychiatric history, treatment information, and family caregiver contact information. You can use an AB 1424 Historical Information Form to provide this information.
• Ask the police officer or ambulance driver where your friend or relative is being taken. If the police believe that the person meets the criteria, they will be placed on a 5150 and transported, typically by ambulance, to a designated facility for psychiatric evaluation and treatment. The individual can be held at a designated facility for up to 72 hours.

Guidance from FERC

What additional steps should we take to prepare or be aware of before the police arrive?

• If there are children present, ask a family member to take them to a different room if possible. These situations can be emotional and upsetting for all family members, especially when a loved one is at risk for self-harm. Keep in mind that your loved one will likely be leaving the home with police officers for evaluation. When removing children from the room, it's a good idea to choose an area that's away from the exit routes used by officers or an area that doesn't have a direct view of the situation.
• Please make sure that any non-essential family members and friends leave the area if possible and create a clear path for the police to enter the house.
• When the police arrive, be prepared for your loved one to react in various ways—they may leave quietly or be very upset or angry. It's important to avoid escalating the situation by arguing or saying upsetting things that may further agitate your loved one.
• When your loved one is being taken to the hospital, preparing a few essential items for their transport is helpful. Ensure that their identification, insurance card, wallet, and phone are readily available if possible. It's also a good idea to check with the transportation officers if any other items are required for the transport. Once your loved one is admitted, family members can typically bring specific designated items to the hospital after the necessary procedures are followed.
• Be aware that jewelry, car keys, and other valuables are removed on admission and returned at discharge. If your loved one is wearing any valuables or jewelry (wedding rings, necklaces, earrings, etc.) and would like to leave them at home, police officers may or may not allow them to remove these items before leaving for the hospital. It never hurts to ask if there is a need or concern.
• The situation may reduce in severity during the evaluation. Depending on the officers' assessment, your loved one may be referred to a lower level of care or diversionary program, if appropriate.
• Staying calm when talking to officers and the emergency response team is crucial. Choose one or two family members to communicate with the officers unless there's a need for input from others. The aim is to give them useful information about the situation without exaggeration or bias. Make sure that the person communicating with the officers is ready to be involved in the hospital setting, as the officers will probably share important details about your loved one's care (ie: where they are being taken, important contacts, etc).

Help has arrived; what is going to happen now?

After calling 911 and speaking with a dispatcher, the dispatcher will contact the appropriate response teams for help. These teams may include police, crisis response mental health teams, fire, and ambulance. It's important to stay calm when the police and emergency response teams arrive. Since you've informed the authorities that it's a mental and behavioral health crisis, they might position police cars, fire trucks, and ambulances discreetly down the street to minimize causing additional distress. They will likely approach without using sirens. Therefore, it's a good idea to be outside or ready to exit your home to speak with the officers before they interact with your loved one.

When the police enter your home, they will start evaluating your loved one for an involuntary 72-hour mental health hold, often known as a 5150. If officers place handcuffs on your loved one or transport them on an ambulance gurney, do not be alarmed—this doesn't mean they are under arrest or physically injured. These measures are normal and carried out to ensure safety. The police will explain to your loved one why they are there and proceed accordingly.

If additional assessment is necessary, your loved one might need to be transferred to the hospital without their consent. In some cases, officers and paramedics could recommend that your family member voluntarily go to the hospital to receive an evaluation by mental health professionals, who will determine if a 5150 hold is necessary. In other situations, officers may believe the best course of action is to arrest your loved one and take them to jail. We'll talk about this more in a minute.

While your loved one is prepared for transport, officers and the crisis response team may speak to you separately to gain additional insight into the situation before heading to the hospital.

Medical Staff / First Responders - What to Expect When They Arrive

If the situation cannot be resolved on-site or if it is recommended by first responders or law enforcement, taking your loved one to the emergency department may be the best option. Handcuffs may be used per usual policy if transported in a law enforcement vehicle. This can be upsetting for everyone involved, but the most important thing is to safely get to a medical facility for evaluation and treatment as soon as possible. You may also be able to transport them in your vehicle or they may be transported via ambulance. After the first responders arrive, you are not in control of these decisions.

A visit to the emergency department does not guarantee admission, as admission criteria vary and depend on medical necessity as determined by a physician and insurance coverage. Be prepared for an emergency department visit to be lengthy, likely several hours. Bring anything that may help the person who is in crisis stay calm, such as books, music, games, etc. Some hospitals have separate psychiatric emergency units that are typically quieter and staffed by mental health professionals and practitioners. Check to see if there is one in your area. Make sure to bring any relevant medical information, including the names and doses of any medications and your crisis kit, if you have one. If you don't have a crisis kit, NAMI has a Portable Treatment Record that can help you develop one. It includes a crisis plan and a relapse plan.

Law Enforcement - What to Expect When They Arrive

When a law enforcement officer arrives, provide them with as much relevant and concise information about the person as you can:

• Diagnosis
• Medications
• Hospitalization history
• Previous history of violence, suicide attempts, or criminal charges.

If the person has no history of violence, make sure to emphasize this. Share the details objectively and efficiently, allowing the officer to make the necessary decisions. Once 911 has been called and officers are on the scene, the situation is no longer under your control. Depending on the officers and your community, they might choose to take the person to jail instead of an emergency room.

Law enforcement officers have the discretion to issue warnings, make arrests, or refer individuals for evaluation and treatment. You can request that the officers approach the situation as a mental health crisis, but it's important to do so without disrespecting their authority. If you disagree with the officers, avoid arguing or interfering. Instead, once they have left, reach out to a friend, mental health professional, or advocate such as NAMI for support and information. If you need to find the NAMI affiliate in your area, you can visit www.nami.org or call 1-800-950-NAMI (6264). If your loved one is not admitted to treatment and the situation deteriorates, don't hesitate to call for help again. The situation can be reassessed, and your loved one may meet the criteria for hospital admission later, even if they didn't initially.

What happens at the beginning of a 5150?

When someone is placed on a 72-hour hold, they must be informed of their rights. The responsible authority or facility must document the situation, detailing how the individual's condition came to their attention, the probable cause for believing the individual is a danger or gravely disabled, and the specific facts supporting this probable cause. General statements without factual backing are not adequate.

According to the LPS Act, when a person is taken into custody:

... [They] shall be provided, by the person who takes him or her into custody, the following information orally in a language or modality accessible to the person. If the person cannot understand an oral advisement, the information shall be provided in writing. The information shall be in substantially the following form:

My name is [name of professional]. I am a [peace officer/mental health professional] with [name of agency]. You are not under criminal arrest, but I am taking you for an examination by mental health professionals at [name of facility]. You will be told your rights by the mental health staff.

Can you explain what an involuntary hold is?

First, it's important to understand what an involuntary hold is and why someone would be considered for involuntary mental health treatment. There are three key reasons someone can be considered for an involuntary hold:

1. A danger to him or herself
2. A danger to others
3. Gravely disabled (unable to provide for his or her basic personal needs for food, clothing, or shelter)

There are several types of involuntary mental health holds in California. The most common is a 72-hour hold, often referred to as a 5150. If an individual requires additional treatment time or care, treating providers and state officials may consider lengthier holds to adequately care for the patient in question.

What is a 72-hour hold or "5150"?

"5150" is the number of the section of the Welfare and Institutions Code which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a 72-hour psychiatric hospitalization when evaluated to be a danger to others or to himself or herself or gravely disabled.

In California, only specific professionals are authorized to initiate a 72-hour hold. These individuals can include police officers, members of mobile crisis teams, or other county-authorized mental health professionals. For someone to be placed on a 72-hour hold, one of three conditions must be met due to a mental disorder: the individual poses a danger to themselves, poses a danger to others, or is gravely disabled and unable to meet basic personal needs like food, clothing, or shelter.

Helpful Tip: Keep an eye out for a follow-up guide on involuntary holds! I'll be sharing this update shortly.

Disclaimer: The information provided is for general informational purposes only and should not be construed as professional, medical, or legal advice. Readers should consult with appropriate professionals regarding their specific circumstances and needs. The author and any associated entities shall not be liable for any losses, injuries, or damages arising from the use of or reliance on the information provided in this article. By accessing and reading this article, you agree to release the author and any associated entities from any and all liability.