Mental Health Emergencies

Many of us have had the misfortune of experiencing a medical emergency; either our own or that of someone we care about.  But did you know people can also experience mental health emergencies?  While mental health emergencies can be just as urgent and distressing as medical emergencies, people are often quite confused as to how to recognize and respond to them appropriately.

A mental health emergency is when an individual presents with a high level of risk factors for serious harm to self or others with relatively few protective factors.  Risk may involve a combination of factors like:  suicide thoughts with potentially lethal means and plan, family history of suicidality, experiencing a recent loss, having limited social support, serious mental illness, physical illness, substance misuse, hopelessness, poor judgment, treatment non-compliance or unwillingness to seek help, impaired self-care, and/or impulsivity.

A person who is at high risk of harming themselves or others often needs acute intervention and 24 hour availability from a team of professionals who are trained and experienced in managing emergent situations.  As with medical emergencies, this type of intensive and acute care is best provided in a hospital setting and is not generally available in a small, private clinic.

Putting a Band-Aid On It

Weekly therapy sessions are the standard for most clients.  However, in some situations, one or even two meetings a week with a private practitioner is not enough.  In fact, it can be downright dangerous for a therapist to treat a serious condition in a clinic when a high risk of harm to self or others is involved.

Imagine if someone went to their family physician with chest pains and the doctor said, “You are having a heart attack.  You need to go to the hospital.”  And the patient replied, “I’m more comfortable with you treating me here. Can I just come back next week and we’ll see how I’m doing?” This is a medical emergency that needs to be treated right away in the appropriate facility and most private practitioners do not have the equipment needed in their offices to manage a health emergency.

Similarly, a private mental health practitioner treating a mental health emergency in their outpatient clinic is like putting a Band-Aid on a gaping wound. A private practitioner can be helpful in guiding clients to the appropriate treatment facility, offer suggestions and make recommendations. This is why most psychologists and counselors make arrangements in advance with their at-risk clients regarding how to contact them in an emergency.

Sometimes a client needs a more rigorous therapeutic environment such as intensive outpatient treatment, parital hospitalization, or inpatient treatment. These programs are designed to meet the needs of people in crisis and they can often manage a variety of complex needs such as safety monitoring, medication management, alcohol or drug abuse treatment, individual and group therapy, and case management. A private practitioner can provide referral options if this is something a client needs.

Responding to Mental Health Emergencies

Mental health professionals respect autonomy and will offer a client some choices for keeping themselves and others safe. They make every effort to balance autonomy and safety and generate the least restrictive options wherever possible. However, in high risk situations, a mental health professional will take decisive action to protect a client or others they may pose a threat to. Psychologists are required by law and by their ethical code to do so.

In general, a mental health professional cannot “hospitalize” a client. It is up to each particular facility to decide who they will admit or not admit for inpatient treatment. However, if the risk factors are high and the client is not cooperative, a mental health professional can call the authorities who may then decide to take the client to a hospital for an evaluation. This is not a decision a counselor takes lightly and will only do so in the most serious of circumstances.

Once a client presents at a hospital, the staff there will do their own assessment and make their own recommendations. Although the private practitioner may provide the hospital staff with information and make recommendations, it is ultimately the decision of hospital staff whether or not a client should be admitted, the type of treatment needed, and for how long they should stay.

What Can I Do in a Mental Health Emergency?

If the emergency is immediately life threatening, you should do what any person would do in any immediately life threatening situation (mental health or otherwise) – which is to call 911. You may feel reluctant to do so, but remember it is better to have someone angry with you than in serious trouble, injured or dead.

Barring an immediate life threatening emergency, you can try to contact the current health provider whether that be a psychologist, psychiatrist or primary care physician. Hopefully the provider has already offered instructions on how to contact them in an emergency, but if not, it is okay to ask “just in case”.

If there is no current provider or you are unable to contact the current provider in a timely manner, you may wish to call a 24 hour crisis line such as 1-800-273-TALK or 1-800-SUICIDE. There are also state and local resources that may be of help such as your local hospital emergency room or state department of mental health crisis line. The following are some examples I use in my office, many of which I include on the back of my business card:

• Johnson Cty (KS) Mental Health Center 913-384-3535
• MO CommCare Crisis Line  1-888-279-8188
• Kansas Child Protective Services  1-800-922-5330
• MO Child Abuse and Neglect Hotline  1-800-392-3738
• Domestic Violence Hotline  1-800-799-SAFE
• MOCSA Sexual Assault Hotline  913-642-0233
• Kansas Poison Control 1-800-222-1222
• Missouri Poison Control  1-888-268-4195

For more information on suicide prevention, please visit the American Foundation for Suicide Prevention (AFSP) or National Suicide Prevention Lifeline. Please also feel free to visit my mental health resources website kansascitymentalhealth.com for more information and resources regarding a variety of mental health concerns.