What is a Psychiatric Emergency?

A psychiatric emergency is a change in a person’s thoughts, mood, or behavior that puts them at risk of harm to themselves and/or others. This could be due to a particular event or high levels of stress. It might also stem from an ongoing mental health issue, like depression, psychosis, or substance abuse. Like a physical health emergency, a psychiatric emergency requires immediate medical attention to ensure everyone's safety.

Recognizing crisis situations helps ensure that everyone involved gets the help that they need quickly. Although it can seem scary to seek emergency help, it can be a life-saving decision. It can also help to prevent things from getting worse and improve treatment outcomes.

In this article, we’ll go over what a psychiatric emergency is and what signs to watch for. We’ll also discuss how to respond to these signs and what psychiatric emergency treatment looks like.

Defining a Psychiatric Emergency

Psychiatric emergencies and mental health crises both involve severe symptoms. These can affect a person's ability to function. But there are some important differences. 

Clinical Criteria

Mental health professionals diagnose psychiatric emergencies by evaluating  at a person's behaviors, symptom intensity, and clinical situationt. They also look at the person's past psychiatric hospitalizations and mental health problems. Mental health professionals may use various assessments and clinical tools. These help them understand the severity of the situation and guide care.

There are different levels of a psychiatric emergency, which are based on a person’s risk and clinical symptoms. High-risk situations involve a significant likelihood of danger to the life of the person or others. This might include suicidal or homicidal ideations with means to do it. In moderate-severity situations, the person feels extreme distress.

However, they are not at immediate risk of harm. Instead, they need to be closely watched to ensure that the situation doesn’t escalate into a high-risk situation. With low-risk situations, a person might have trouble caring for themselves or coping with the demands of daily life, but there is no threat to life. A safety plan and outpatient care may help manage these situations.

Crisis vs. Emergency Distinction

It’s important to differentiate between a crisis and an emergency situation. While both can involve significant amounts of distress, the major difference is the risk of harm. For example, a person who is having a mental health crisis might have difficulty coping or functioning, but they’re still able to keep themselves safe. Crisis hotlines or outpatient support may be enough to manage the situation. 

With an emergency situation, there is an immediate and severe risk of harm.  This means that someone needs urgent medical or psychiatric attention. A person may need to be hospitalized or responded to by a crisis care team to help keep them safe and stabilize their symptoms.  

Risk Factors That Escalate Situations

There are some risk factors that may escalate situations. These include:

• High-stress or unstable living situations.
• Lack of social support.
• Major life changes, such as the death of a loved one or the loss of a job.
• Access to lethal means, such as weapons or large amounts of medication.
• Experiences of trauma or abuse.
• History of suicide attempts. 
• Stopping psychiatric medication suddenly, without medical supervision.
• History of past violence.
• Alcohol or substance use.
• Prior psychiatric hospitalization.

There are also some signs to watch for before a crisis escalates into an emergency. These include:

• Becoming socially withdrawn.
• Lack of personal hygiene.
• Significant changes in sleep or eating habits.
• Increased use of substances  or alcohol.
• Expressions of hopelessness or references to death or self-harm.
• Acting unusually or not making sense.
• Uncooperativeness or suspiciousness.
• Increased aggression or reckless behavior.

Getting help during a mental health crisis can prevent it from progressing into an emergency.

Common Types of Psychiatric Emergencies

Knowing the common types of psychiatric emergencies can help you identify warning signs in your loved ones. This way, you can support them in getting help sooner.

Suicide Risk and Ideation

Suicidal ideation is one of the most common types of psychiatric emergencies. While as many as 1 in 5 people experience suicidal thoughts, there’s a difference between active and passive suicidal thoughts. With passive suicidal thoughts, a person might have thoughts about harming themselves or death, but they have no immediate plans to do so. Proper outpatient treatment may be able to treat their symptoms. However, it’s important to note that passive suicidal thoughts can progress into active suicidal thoughts. 

With active suicidal thoughts, the person has a plan to harm themselves and has access to the means to do so. Because there’s an immediate threat to life, this is a psychiatric emergency. 

Psychotic Episodes

Psychosis affects an individual’s ability to reality test. This can include delusions (believing things that aren’t true) and hallucinations (seeing or hearing things that aren’t there). Schizophrenia, substance and alcohol use, and bipolar disorder can cause psychotic episodes.

Hallucinations and delusions may  cause a person to participate in unsafe behaviors. Untreated, they may  lead to aggression, which can put others at risk. Because of this, psychotic episodes need prompt treatment to stabilize symptoms. 

Severe Mood Episodes

Mood disorders, such as depression, anxiety, and bipolar disorder, can cause psychiatric emergencies. This often happens when there are severe and rapid changes in mood. For example, a person with major depressive disorder (MDD) may develop psychotic features and engage in unsafe behaviors. Or someone with bipolar disorder might have a manic episode and engage in risky behaviors that put themselves or others at risk. 

Panic Attacks and Severe Anxiety

Anxiety disorders are the most common mental health conditions. While they are usually treated successfully with outpatient treatment, in certain situations, severe anxiety can be a psychiatric emergency when an individual loses control over their behavior. The overwhelming feelings that anxiety can cause can also lead to substance abuse, which can become a psychiatric emergency.

While panic attacks can have intense symptoms, they’re generally not physically harmful. However, there is some overlap between panic attack and heart attack symptoms. Any new or worsening chest pain warrants a medical check.

Substance-Related Emergencies

Individuals with a substance use disorder engage in harmful substance use. This could involve illegal drugs, alcohol, or misusing prescription or OTC medications. Sometimes, people who use substances engage in behaviors that can put themselves or others at risk. They might also take too much, which can put them at risk of an overdose. Both of these situations are psychiatric emergencies.

Sometimes, an individual who uses substances may try to stop on their own. This may lead to withdrawal symptoms. Some withdrawal symptoms, like seizures and psychosis, are emergencies. It's important to note that someone may need to consider dual diagnosis treatment. For example, a person may have a substance abuse disorder due to an underlying mental health condition like major depressive disorder (MDD).

Self-Harm Behaviors

Most people who self-harm can be treated with outpatient care. However, some self-harming behaviors may cause serious injuries that need urgent medical help. It’s also important to watch for escalating thoughts and behaviors in individuals who self-harm. For example, some self-harming thoughts can progress to suicidal thoughts. If the person has a plan for suicide and the means to do so, it’s an emergency situation.

Behaviors That Are Harmful to Others

Sometimes, the strong emotions of mental health conditions can cause individuals to engage in behavior that puts others at risk. This can include aggression, like violently attacking someone, and unsafe behaviors, such as speeding or running into traffic. Neglect of others, such as children or pets, can also put others at risk. 

Warning Signs to Watch For

Being aware of the warning signs to watch for can help you ensure that someone having a psychiatric emergency gets the help they need.

Behavioral Changes

Behavioral changes to watch for include sudden personality shifts and erratic or dangerous behavior. For example:

• Withdrawing from friends and family members.
• Not participating in usual activities.
• Extreme irritability or hopelessness.
• Lack of emotion.
• Difficulty keeping up with daily responsibilities, including at work and school.
• Giving away possessions or saying goodbye to loved ones.
• Increased risk-taking.
• Extreme changes in behavior, such as a shift from deep depression to happiness.

Verbal Indicators

Verbal indicators include threats or concerning statements, or changes in speech patterns. For example:

• Expressions of hopelessness or being a burden, such as “I wish I had never been born.”
• Direct or indirect references to death or suicide, such as “Everyone would be better off without me.”
• Disorganized speech.
• Threats of violence toward others.
• Paranoid or unusual statements, such as “I’m being followed everywhere I go.”
• Sudden changes in speech, such as talking quickly or loudly.

Physical Symptoms 

Physical symptoms include medical complications and signs of self-neglect. For example:

• Not eating or sleeping.
• Neglect of basic hygiene.
• Noticeable weight loss or gain.
• Dressing inappropriately for the weather, such as wearing long sleeves in hot weather.
• Repeated, unexplained injuries.
• Ignoring medical needs, such as not taking medications for health conditions.
• Signs of substance abuse or withdrawal, such as tremors.

Immediate Response Steps

The immediate goal is to help everyone stay safe and get professional help as quickly as possible.

Ensuring Safety

While it’s natural to want to keep the person who is having a psychiatric emergency safe, it’s important to keep yourself safe first. Keep in mind that you can’t help the other person if you’re not okay yourself. Keep a safe distance, and position yourself near an exit should you need to leave. If you’re able to, clear any potential weapons or dangerous objects. It’s also important to avoid touching the other person unless absolutely necessary.

Avoid any prolonged eye contact, and stay to the side of the person if possible. When a person is having a psychiatric emergency, they can act in unexpected ways. Crowding them or approaching them head-on may feel threatening. Instead, focus on giving them space and time to calm down.

When to Call Emergency Services

Call 911 when the person is an immediate safety risk to themselves or others, or if they are experiencing concerning medical symptoms. If someone else is nearby, you can tell them to call 911 while you stay with the person who is having the emergency. When calling 911, let them know where you are and that someone is having a psychiatric emergency.

You’ll also want to let them know what the major cause of concern is (for example, suicidal thoughts) and if there is any safety risk. You can also let them know if the person has any triggers, such as loud noises. This helps emergency services focus on providing help in a way that keeps everyone as safe as possible.

Communication During Crisis

When communicating with someone during a crisis, keep your voice slow and steady, and avoid raising your voice. The goal is to show empathy without judgment. For example, “I can see that you’re really upset right now.” It’s also important to let them speak without interrupting. Show that you’re listening by reflecting their emotions back to them once they’re done speaking.

When someone is having a psychiatric emergency, it can be natural to want to change the situation.

But stabilizing symptoms is the job of mental health professionals. As a support person, your goal is to keep the situation as safe as possible until professional help is available. Saying things like “You need to calm down” or trying to reason away any hallucinations or delusions can feel confrontational. Even if there’s no real threat, it feels very real and scary to the person having the crisis. Instead, remind the person that you’re there with them and recognize the emotions that they’re feeling.

Available Emergency Resources

A mental health crisis can be very overwhelming for everyone involved. But there are several options available for help.

Emergency Departments

At the emergency department, a mental health professional will assess the person to determine if they pose a risk to themselves or others. They often do this by asking questions and observing behavior.

The person will also undergo a medical examination to ensure that there isn’t an underlying medical condition. Emergency psychiatric services can evaluate and stabilize a person. They can also refer them to inpatient or outpatient treatment. 

If the person in the emergency room has any urgent medical concerns, such as injuries, the medical staff will treat them. A doctor will also perform a complete medical exam. It’s estimated that about 50% of people who go to the emergency room for a psychiatric emergency also have a medical condition. Knowledge about this medical condition helps provide more complete and effective care.

Crisis Hotlines and Text Services

If someone faces a mental health crisis that isn't urgent, they can use crisis hotlines and text services. These resources help keep the situation from turning into an emergency.

Crisis hotlines and text services connect callers or texters with trained crisis counselors. These trained crisis counselors can provide a safe space for active listening and help de-escalate difficult emotions. They can also provide next steps to help the person stay safe.

Suicide & Crisis Lifeline: Call or text 988, or visit 988lifeline.org for online chat.

Crisis Text Line: Text HOME to 741741.

Crisis Text Line for young people of color: Text STEVE to 741741. 

National Mental Health Hotline: Call 833-789-8713. 

Veterans Crisis Line: Call 988 and press 1, text 838255, or visit https://www.veteranscrisisline.net/get-help-now/chat/ for online chat. 

Trans Lifeline: Call 1-877-565-8860.

LGBT National Hotline: Call 1-888-843-4564.

Mobile Crisis Teams

If a person isn’t in an emergency situation but is unable to call or text a crisis line, then a mobile crisis team can be called. This is a team of mental health professionals who can help to de-escalate a person in person. They can also assess a person, create a safety plan, and coordinate the next steps of care. You can request a mobile crisis team by calling 988.

What to Expect During Emergency Treatment

Knowing what to expect during emergency treatment can ease anxiety about seeking treatment.

Assessment Process

Both a medical and a mental health assessment will be performed in a safe environment.  A mental health professional will assess a person's safety and risk. This helps to decide the treatment needed. They'll ask about:

• Symptoms that brought them in.
• Past mental health issues.
• Current medications.
• Family history of psychiatric conditions.

They’ll also ask about a person’s living situation and social support to determine how safe and supportive their home environment might be. With the patient’s permission, a mental health professional might speak to a friend or family member to learn more information. 

Treatment Options

Some people worry that going to the emergency room means that they’ll automatically be admitted to the hospital. But this isn’t the case. Most people who visit the hospital for mental health issues aren’t hospitalized. Doctors admit patients for hospitalization only when they can’t safely or properly treat them as outpatients.  At the hospital, treatment may involve:

• Medication management.
• Referral to outpatient support.
• Crisis intervention.

If necessary, the medical team might admit the patient to inpatient treatment to provide them with a safe place to help stabilize their symptoms. 

Discharge Planning

Before discharge, the mental health team and the individual will put together a safety plan. This is a list of steps they can take when they’re experiencing difficult thoughts and emotions. They’ll also coordinate follow-up care to help the person continue to receive treatment after discharge. With the patient’s consent, the safety plan can include friends and family members. They’ll be taught what signs to look for and any steps to take to help prevent and manage future crises.

Follow-Up Care and Prevention

Properly planned transitions and a strong support system can help avoid future psychiatric emergencies.

Transition Planning

Transitioning from a hospital setting to home can be a major change. Connecting with outpatient treatment can help ease this transition and ensure that the person receives support at home. The mental health team may offer contacts for psychiatrists or therapists. This can help with ongoing treatment. They can also provide a list of emergency contacts, including crisis lines and mobile crisis teams. In some cases, the mental health team might arrange for regular check-ins after discharge. This can help support the person and prevent a future crisis. 

Building Support Networks

Family and community involvement can also be helpful. The mental health team may give you contacts for local mental health organizations. They might also suggest specific support groups and peer programs. In some situations, they’ll assign a social worker or case manager. These individuals can help with navigating insurance and ensuring that the person is able to afford their prescribed medications. They can also help provide support with housing, finances, and employment as needed.

Sources

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