The Performing Arts Medicine Association (PAMA)’s recent mental health webinar series was important and illuminating in many ways, but one point that really stuck with me was one made by Dr Leigh Skvarla, a counsellor based in Pittsburgh, USA. She noted that while students and staff at various dance schools, companies and organisations are familiar with emergency plans such as their institution’s fire drill, it is far less common that there are equivalent plans in place for mental health emergencies. So, how do you support someone in crisis? This blog highlights some key points for creating your own plans.
Please note that this is not a blueprint, just a starting point, and some information is relevant to UK-based organisations only. If you are based outside of the UK, make sure that identifying relevant services and their contact details is part of preparing your plan: don’t wait until a situation of this nature occurs. Make sure that you know the numbers of all relevant services, as well as other services you could recommend. In the UK that could include Mind’s crisis cafes, the Stay Alive app, the NHS IAPT service, or various helplines supporting mental health in general as well as those for people in crisis.
What is a mental health crisis?
What constitutes a mental health crisis will differ according to the individual, but generally speaking a crisis can be defined as an episode where an individual is at risk of harming themselves or others. They may be overwhelmed and unable to use their usual coping strategies. Example of crises include panic attack, self-harm, mania, psychotic episodes (e.g., where the person has strong delusions or hears voices), and suicide.
Remember that, unless you are a trained mental health professional, it is not your job to try and 'cure' the person in crisis. Instead, stay with them and help to keep them safe either until the episode passes, or until the relevant services arrive.
Supporting someone who is not at immediate risk of harming themselves or others
Find somewhere quiet and private that you can take the person. See if any immediate concerns need to be attended to, such as any physical wounds, or ask if the person is hungry or thirsty. If you are unsure about what to do, and need help but do not feel the situation is an emergency, call NHS 111.
Try to:
Listen non-judgementally. Let the person talk openly and let their feelings out. If they aren't willing to talk to you, that’s ok – don’t try to force them to speak
Reassure the person. Let them know that people care about them
Try to stay calm – even if you don’t feel calm inside, try to act and speak in a calm way
Avoid offering specific advice or ideas. It is much more helpful to listen and reassure the person
Avoid dismissing or confirming things that someone might be hearing, seeing or believing during a psychotic episode. Remind them that you are there.
Be patient: episodes of crisis may last several hours. Ask others for support or to give you a break if you need one, but make sure that someone stays with the individual in crisis
Supporting someone who is at immediate risk of harming themselves or others
It is imperative that you take any mention of suicide seriously. If you are worried about the person, ask very direct questions. Do not try to skirt around the issue, challenge the person, or ‘talk them out of it’, as this may make things worse. Try not to ask them "why" they feel like this, as it invites them to defend their thoughts, feelings and behaviours. Individuals will not always use the word suicide explicitly (for example, they may say things like, “I’m thinking about doing something silly”), so it is important that you identify what they mean, and determine whether they are referring to self-harm or suicide. If you have ascertained that they mean suicide, ask them if they have made a plan, and try to ascertain if they have the means to carry it out. Ask about their history: people who have made attempts in the past are at greater risk of dying by suicide. If you can, remove things that the person could use to harm themselves: try and do what you can to keep the person safe in that moment. Do note that in some cultures and religions, suicide is considered sinful, so the individual may feel unable to use the term specifically. In this case, trust your instincts – don’t worry about over-reacting by calling the emergency services. The safety of everyone involvement is paramount.
Feeling suicidal is often temporary, but should always be treated as an emergency. In the UK, there are a range of options for seeking support. You could:
Call the individual’s GP and request an emergency appointment
Call the local NHS urgent mental health helpline. This service is 24/7 but if you cannot get through, try NHS 111
If the individual is already registered with a local NHS community mental health team, you could call them
Call 999 and ask for an ambulance. If the individual has made a plan and has the means to carry it out, make sure you tell the responder this – they will send an ambulance more urgently
Go to your nearest hospital A&E department if the individual has harmed themselves
Stay with the individual until help arrives or they have an appointment confirmed. Ideally, go with them to the appointment so that you can explain what has happened.
During a mental health crisis, people are far more likely to cause harm to themselves than to others. However, if the individual is using threatening language, or has a weapon or means of causing harm and expresses a desire to hurt others, call 999 and ask for the police. If your building has security personnel, call them immediately as well.
Supporting yourself afterwards
Witnessing or supporting someone in crisis can be very distressing, so make sure that you allow yourself to process what has happened afterwards. Talk to someone you trust about what you have been through, try relaxation exercises, or use journaling to express your thoughts and feelings. Remember that regardless of what has happened, you are not responsible for someone else's thoughts, feelings or actions. You can also seek professional help, for example through the NHS IAPT service, SANEline, or speak to your GP.
Other useful helplines and websites:
Samaritans (listening service): 116 123
CALM (crisis line): 0800 58 58 58
SANEline (for individuals and those supporting them): 0300 304 7000
The Mix (mental health support for young people under 25): 0808 808 4994
Papyrus (suicide prevention for young people under 35): 0800 068 41 41 or text 07860 039 967
Silver Line (helpline for over 55s): 0800 4 70 80 90
Shout (a text service for people who prefer not to talk): 85258
The information for this blog came from training in mental health first aid, and suicide awareness and prevention. You can also find excellent, detailed information from Mind (which has a really helpful planning for a crisis page) and Rethink Mental Illness.