What to do in a mental health crisis? Read the first steps for yourself or someone close, when to call 112 and how support can continue after the crisis passes.
Important note: if your life or someone else's life is in danger right now, or if thoughts of harming yourself or another person are about to turn into action, stop reading this article and call 112 (emergency services) immediately, or go to the emergency department of the nearest hospital. Do not stay alone; tell someone near you what is happening.
At two o'clock in the morning your phone rings and your sibling's name appears on the screen. When you answer, they say between sobs, "I can't take it any more." Or perhaps it is you in that moment: your heart feels as if it is about to burst out of your chest, your thoughts are tangled and you do not know what to do. The question of what to do in a mental health crisis usually confronts us precisely at the moments when we are least able to think clearly. That is why knowing in advance makes it easier to take quick, appropriate steps when a crisis comes. In this article I explain what a psychological crisis is, in which situations emergency help is needed, the first steps you can take for yourself and for someone close to you, and how support can be continued after the crisis has passed.
What Is a Psychological Crisis?
A psychological crisis is a state of intense distress in which a person's usual ways of coping fall short, the emotional burden feels unbearable and everyday functioning suddenly breaks down. A crisis is not a diagnosis but a situation; it can happen to anyone.
The events that trigger a crisis can be very varied:
- A sudden loss: the death of someone close, a separation, a divorce
- A traumatic event: an accident, an assault, a disaster such as an earthquake
- Job loss, a large debt or financial collapse
- Stress that has been building for a long time overflowing at some point
- The sudden worsening of an existing mental health condition
- A diagnosis of a serious illness
Sometimes a crisis can also begin with an event that looks small from the outside. For someone who has been struggling for a long time, the last straw may be an exam result or an argument. What matters is not the size of the event but the intensity of the burden the person is carrying at that moment.
In Turkey, after the 6 February 2023 earthquakes, many people came to know the experience of crisis this closely for the first time. Those waiting for news of relatives under the rubble, those who lost their homes, those who watched footage on screens for hours and could not sleep; all of them went through a crisis of differing intensity. This experience showed clearly that a crisis is not something that happens only to "weak" people, and that when circumstances become heavy enough, anyone's capacity to cope can be overwhelmed. That is why thinking in advance about what to do in a mental health crisis is a kind of preparation for psychological first aid.
What Are the Signs of a Psychological Crisis?
During a crisis, marked changes may be seen in the body, thoughts, emotions and behaviour:
- Emotional: intense fear, panic, helplessness, hopelessness, uncontrollable crying, outbursts of anger or, conversely, emotional numbness
- Physical: palpitations, shortness of breath, trembling, dizziness, nausea, being unable to sleep
- Cognitive: thoughts racing or stopping altogether, being unable to make decisions, thoughts such as "It's all over", feeling detached from reality
- Behavioural: shutting oneself away, not speaking to anyone, not eating, drinking excessive amounts of alcohol, recklessly engaging in dangerous behaviour
Some of these signs can also be seen in a panic attack. Although a panic attack is very frightening, it usually peaks within minutes and gradually subsides. For more detail you can have a look at the article on panic attack symptoms. However, if physical symptoms such as chest pain or shortness of breath are appearing for the first time, an urgent medical assessment is essential to rule out a medical cause such as a heart problem.
When Should You Call 112 Straight Away?
The first and most important answer to the question of what to do in a mental health crisis is to ensure safety. In the following situations, 112 should be called or the nearest emergency department visited without losing any time:
- If the person says they are thinking of killing themselves and mentions a plan or a means
- If they have harmed themselves or are about to
- If they say they will harm someone else, or are behaving aggressively
- If they appear to have lost touch with reality, for example hearing voices that others do not hear or acting on beliefs that are dangerous for them
- If they have taken excessive alcohol, drugs or medication and their consciousness is clouded
- If serious physical symptoms such as chest pain or fainting accompany the situation
When you call 112, try to stay calm, state your address clearly, and describe the person's condition and any substances or medication they have taken. The call handlers will tell you over the phone what you need to do. Do not hang up until they tell you to.
In a crisis, your aim is not to solve the problem but to get through the moment safely; solutions are found later, with a calmer mind.
For Yourself: What to Do in a Mental Health Crisis
If there is no danger to life but you feel caught in unbearable distress, the following steps may help you reduce the intensity a little:
1. Get yourself to a safe place
Move away from objects that could be dangerous. If possible, go to a room where you are not alone, or call someone you trust to come and be with you. If you are driving, stop somewhere safe.
2. Calm your body
Try to slow your breathing: breathing in for four seconds and out for six helps send your nervous system the message that "the danger is passing". Washing your face with cold water or holding a piece of ice in your hand are also methods used to bring sudden intensity down.
3. Come back to the present
When your mind races into the future or the past, bringing your attention back to the moment you are in helps. Simple methods such as naming five things you can see around you, four things you can touch and three sounds you can hear can help with this. For the details of these techniques, you can read the article on grounding techniques.
4. Reach out to someone
Call a family member, a friend or a neighbour. If you do not know what to say, saying "I'm feeling really bad right now, can we talk for a bit?" is enough. If you are in therapy and your therapist has agreed a way of getting in touch during a crisis, use it.
5. Postpone big decisions
In a crisis it can be tempting to quit your job, end a relationship or make other decisions that are hard to reverse. If possible, postpone these decisions for a few days, at least until the emotional intensity has eased.
6. Stay away from alcohol and drugs
Although alcohol or drug use may seem to bring momentary relief, it increases impulsivity and can make a crisis more dangerous. If you have a drink in your hand, putting it to one side is a small but important step you can take to get through the crisis more safely.
What to Do in a Mental Health Crisis for Someone Close to You
Seeing someone close to you in crisis can be frightening and can leave you feeling helpless. In this situation, the following steps can guide you:
- Try to stay calm: your tone of voice and manner help the other person calm down. Speaking fast, shouting or panicking can escalate the situation.
- Listen without judging: avoid sentences such as "You're exaggerating", "Pull yourself together" or "There are people worse off than you". Instead, say "I'm here, I'm listening to you."
- Ask directly: if you suspect suicidal thoughts, do not hesitate to ask openly: "Are you thinking of harming yourself?" Asking this question does not put the idea into the person's head; on the contrary, it makes them feel they can talk.
- Do not leave them alone: if there is a risk, stay with them until professional help arrives, or make sure someone else you trust is with them.
- Remove dangerous items: put things that could be used to cause harm, such as medication or sharp objects, somewhere out of reach.
- Direct them to professional help: if necessary, call 112 yourself and offer to take the person to the emergency department.
Let's say that, after the university entrance exam results have been announced, your seventeen-year-old daughter has shut herself in her room, will not open the door, and is not answering the messages you have sent to her phone. You know how heavily the exam result has weighed on her. At a moment like this, it is important to speak in a calm voice outside the door, to say "Whatever the result, we love you, you're not alone", and to call for help without waiting if there is no sound from inside or there are signs of risk. For more comprehensive information on suicidal thoughts, you can read the article on suicidal thoughts.
While supporting someone close to you, do not forget yourself. It is entirely natural to feel tired, frightened and guilty after a crisis. You too may need to share this experience with others.
After the Crisis: How Can Support Be Continued?
When the moment of crisis has passed, it is easy to think that everything is over. Yet the days and weeks after a crisis are at least as important as the crisis itself, both to prevent it from recurring and for recovery to continue.
During this period, the following steps can be helpful:
- Get a professional assessment: after an initial assessment in the emergency department or by a psychiatrist, a regular course of psychotherapy can be planned.
- Create a safety plan: together with a professional, turn into a written plan what you will do when the signs of crisis start again, whom you will call and how you will keep yourself safe.
- Learn the early warning signs: signs such as disrupted sleep, withdrawing from people and an increase in hopeless thoughts can indicate that a crisis is approaching. Noticing them gives you a chance to intervene early.
- Widen your support network: having a few people you trust know about your situation means you will not be left alone when you struggle again.
- Return to basic needs: simple routines such as regular sleep, nutrition and short walks help a shaken nervous system to find its balance again.
If you went through the crisis together with someone close to you, it is also valuable to talk about what happened at a calm time afterwards. An open question such as "I was really worried about you that night; how are you now?" helps break down the wall of silence. Never talking about what happened, on the other hand, can feed the person's sense of shame and make it harder for them to ask for help the next time things get difficult.
When Should You Seek Professional Support?
Even if the moment of crisis has been overcome, professional support should definitely be sought in the following situations:
- If there were suicidal thoughts or self-harming behaviours during the crisis
- If similar crises keep recurring
- If marked disruption in sleep, appetite, work or school life continues for weeks after the crisis
- If the person is experiencing nightmares, sudden flashbacks or intense avoidance related to the traumatic event they went through
- If alcohol or drug use has increased
These signs do not on their own mean a diagnosis; but they do show that a professional assessment is needed. Where necessary, assessment by a psychiatrist and psychotherapy can be carried out together.
How Is the Post-Crisis Process Addressed in Therapy?
In individual therapy, post-crisis work usually begins with safety. The first goal is for the person to feel safe and to know what they can do if the signs of crisis reappear. To this end, the therapist and client prepare a personalised safety plan together.
In cognitive behavioural therapy, the chain of thoughts, feelings and behaviours that led to the crisis is examined step by step. The evidence for and alternatives to thoughts such as "There's no way out" are considered together. Work is done on emotion regulation, problem-solving and distress tolerance skills. Skills adapted from dialectical behaviour therapy are also often used to reduce impulsive behaviour at moments of crisis.
If the crisis began with a traumatic event, trauma-focused work is only taken up once the person has gained sufficient stability. Throughout the process, informing family members or those close to the person can be planned with the person's consent and with due regard to the principles of confidentiality. The aim is not only to get through the crisis, but to be able to face the next difficult period with stronger resources.
Frequently Asked Questions
Should I go to hospital during a psychological crisis?
If there are situations such as a danger to life, a risk of harming yourself or someone else, or losing touch with reality, then yes, you should call 112 or go to the nearest emergency department. If these risks are not present, it is appropriate to get in touch with someone you trust and to see a mental health professional as soon as possible.
Can I call my therapist during a crisis?
This depends on the arrangement you made with your therapist at the start. Many therapists discuss in advance how to get in touch in an emergency. However, your therapist may not be reachable at every moment; so in urgent and life-threatening situations, 112 should always be called first.
Can a crisis happen again once it has been overcome?
Some people experience a crisis only once in their lives, while for others it may recur. Understanding the factors that trigger the crisis, recognising early warning signs and having a safety plan can reduce the likelihood of recurrence and help you face a new difficult period better prepared.
What should I do if my child is in crisis?
First make sure they are safe, stay calm and listen to them. If there is a risk, call 112 without waiting. Once the crisis has passed, it is helpful to see a mental health professional working with children and adolescents for an assessment appropriate to their age.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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