What to do in a mental health crisis

Information for adults and older people about what to do in a mental health crisis.

The following information is for adults over the age of 18.

If you are feeling low, sad or worried but are not experiencing a mental health crisis, there is a range of mental health support you may wish to consider. We are here for you, whenever you feel ready.

Dealing with a mental health crisis

If you experience mental health problems, it can be frightening, and you may feel alone. If this is a new experience, you may not know what is happening.

If a person’s mental or emotional state gets worse quickly, this can be referred to as a mental health crisis or a mental health emergency.

A mental health crisis can mean different things to different people, but often means that you no longer feel able to cope or in control of your situation. It can cause a significant disruption to your life and your ability to function.

A crisis can also be the result of an underlying medical condition, such as confusion or delusions caused by an infection, overdose, illicit drugs or intoxication with alcohol. Confusion may also be associated with dementia.

You may feel many things (although this may be different for individuals) including emotional distress or anxiety, that you can’t cope with day-to-day life or work, you might think about suicide or self–harm, or you might experience hallucinations and hear voices.

It may be an existing problem getting much worse or your first experience of a psychiatric problem.

A crisis can also be the result of an underlying medical condition, such as confusion or delusions caused by an infection, overdose, illicit drugs, or intoxication with alcohol. Confusion may also be associated with dementia.

You might be in crisis if:                               

• you are thinking of hurting yourself or suicide seems the only option
• you are experiencing extreme distress that seems overwhelming, which may relate to current/past trauma
• you are experiencing psychotic episodes (loss of sense of reality, hallucinations, hearing voices) and / or other behaviour that seems out of control or irrational and that is likely to endanger the person or others.

In a crisis, it is important to get help quickly. Whether you experience a sudden deterioration of an existing mental health problem, or are experiencing problems for the first time, you may need immediate support and / or assessment to identify the best course of action and stop you getting worse.

Call NHS 111 select mental health option

If you are experiencing a mental health crisis, call NHS 111 and select the mental health option. This is option 2. Please use NHS 111 – SignVideo if you are deaf or have hearing loss.

You will then be asked to select the most appropriate regional area for you.

Your call will be answered by a mental health professional, who will be supported and supervised by our trained mental health clinicians. They work within our crisis services.

A ‘call back’ option is available so you can always keep your place in a queue.

To get the support you need, the mental health professional will ask you some questions and listen to you. They will provide reassurance and make sure you are directed to the most appropriate professional or service. They can

• Transfer callers to the crisis teams for triage and assessment if this is needed
• Refer to primary care services for further support, for example, your GP
• Refer to community services that are alternatives to crisis, for example, the voluntary sector
• Contact 999, if there is a risk to life

Some of the mental health professionals are employed by our Trust and some work for mental health organisations in the voluntary care sector that we work in partnership with. To ensure we always provide high quality and safe care, they all use the same Trust telephony and electronic patient record system.

In line with our Sharing information and Confidentiality Policy, sometimes information must be shared and confidentiality breached if it is in the best interests of a service user or in the public interest. For example, if a member of staff is concerned about a risk of harm to the caller or to other people, they would have a duty of care to report this and take steps to ensure everyone is safe.

Details of a call will be logged in the Trust’s electronic patient record system, where a mental health record will be created.

All calls will be recorded.

Our crisis resolution and intensive home treatment service (CRHT) is not changing.

People already receiving treatment for their mental health

If you are already receiving treatment and support for your mental health from your GP or a community mental health team, the first point of contact should be with them or your care coordinator / named worker.

If you have previously had similar symptoms, then you might find it useful to think about what helped you cope before.

Your care plan and / or a crisis and safety plan will identify what you (and others) can do to help. It will also include details of who to contact in an emergency and outside of the team’s operational hours.

It is best to seek help from professionals that know you well as they can help support you better.

If there is an immediate risk

If you are worried about your own safety or you are close to acting on suicidal thoughts, contact NHS 111 select mental health option, tell someone who you trust or call a local support line immediately.

Call 999 or go to A&E if:

• you, or someone you know, have physically harmed themselves, or if their life is at risk
• there is a medical emergency and you, or someone you know are seriously ill or injured

When you speak to a 999 operator, be as clear as you can when giving your address and telephone number.

Our liaison psychiatry and crisis and home treatment teams work closely with the acute hospitals/accident and emergency departments to make sure that you can be treated for a mental health illness where needed.

If there is a risk of physical violence, or if you are at risk of self-harm or of causing harm to someone else, it may be necessary to contact the police directly by calling 999.

Injuries or other physical health problems

Local pharmacy teams can help with advice and treatment for a range of common health concerns – you don’t need to make an appointment.

You can also contact your GP practice for face to face, telephone, or online appointments.

For everyday illnesses and injuries, people can use the NHS 111 online symptom checker. You may be redirected to a health professional if you need to be seen by someone. Also, self-care advice is available online from the NHS.

Call NHS 111 and press option 1 if you urgently need medical help or advice for your physical health, but it’s not a life-threatening situation. NHS 111 is free to call and available 24/7. Text phone: 18001 111

If you need someone to talk to

If you want to call someone about how you feel or how to deal with someone else’s behaviour, you could contact one of the following helplines for immediate assistance.

These helplines have specially trained volunteers who will listen to you, understand what you are going through and help you through the immediate crisis.

Samaritans

Telephone: 116 123 (free to call service open 24 hours a day, 365 days a year for people who want to talk in confidence)

Email: [email protected]

SANEline

Telephone: 0300 304 7000

NHS choices

The NHS website has some useful information, advice and support.

Careline

Telephone: 0845 122 8622 (Monday – Friday, 10am-1pm and 7pm-10pm)

MIND

Telephone: 0845 766 0163 (Monday – Friday, 9am-5pm)

Every mind matters

NHS – Every Mind Matters

You can also text SHOUT to 85258.

There may also be local crisis cafés in your area that could support you – www.nhs.uk is a good place to find information.

Recovery College Online

The Recovery College Online, provides a range of free online mental health educational courses and resources. The content of the site has been developed by people with experience of mental illness.