In this article, I want to talk with you about the proper ways to handle a psychiatric emergency.
The fundamentals of handling these intense situations never change regardless of your location. Even if you’re reading this from a computer outside of Houston city limits, you can apply many of the things I’ll talk about to any emergency situation you face.
Before talking about the ways to handle psychiatric emergencies we need to discuss the different types of psychiatric emergencies.
I’m going to provide you with great detail regarding the types of emergency situations, but the following statement is the easiest way to recognize a psychiatric emergency:
Anyone who acts in a manner that is a danger to themselves or others should seek hospitalization.
If you can remember that phrase you will always make the right decisions regarding psychiatric emergencies.
Types Of Psychiatric Emergencies
The four types of psychiatric emergencies I will discuss are suicidal ideations, homicidal ideations, psychosis and.
If you or someone you know is having suicidal thoughts this doesn’t always require hospitalization. Many individuals have suicidal thoughts on a weekly or even daily basis. Some simply wish to escape the psychological pains they’re enduring. Instead of wanting to end their life they experience thoughts of wanting “to get away” or “disappear”.
For some, obligations like caring for their children, aging parents or even the buried belief that their situation will eventually improve protects them against self-harm. Despite having the coping skills to manage ongoing suicidal thoughts it’s important that you or someone you know seek treatment for your struggles. If hospitalization isn’t necessary but you want outpatient treatment, refer to our article titled Low-Cost Psychiatric Clinics In Houston. There you’ll find a complete listing of inexpensive options available to you.
When determining if you or someone else who is experiencing suicidal thoughts needs hospitalization consider the following questions:
- Is there a timeframe for attempting suicide? Tonight? If they lose their job? If divorced? Once the kids are taken to safety? If a timeframe is given the individual should be admitted to a psychiatric hospital for further evaluation. Even if the timeframe is potentially months away it’s best to get the individual help as soon as possible, especially if they are accepting of treatment.
- Is there a concrete plan? Do they plan on using a gun, cutting themselves, overdosing? Anyone with a detailed plan for harming themselves should be taken seriously. It’s one thing to wish you could “disappear”, but planning for suicide makes the situation even urgent. If the individual is willing to see a mental health professional at that moment, it’s best to help them find treatment.
- Do they have the means? Does this person have access to a gun, knife or drugs? Some who consider the thought of suicide lack a plan or even means to do so. This is a good sign because it buys you more time to develop a plan. However, if an individual states a plan and reveals that they have access to a weapon this person should be immediately hospitalized. Ask if they can leave the room that the weapon is in or even visit a neighbor until you can arrange to get them help.
- What type of support to they have access to right now? Live with family, homeless, are they here attending university and have no support in town? If they have support try communicating with those individuals. Even if the individual is reluctant or embarrassed to tell their family about the thoughts of suicide it is your duty to advise them of these thoughts. Try making contact with family and provide them with as much information as you can. If the individual lacks support try to get them professional help right away; (if safe) taking them to the nearest ER yourself or contact a local crisis team.
- Have they attempted suicide in the past? Last week, past Christmas, never attempted? If they have a history of attempting suicide during depressing times like the holidays try making arrangements to ensure they are supported during these times. If someone has attempted suicide within the past year it’s best that they seek out hospitalization as soon as possible to prevent an additional attempt.
- Are they taking psychiatric medications? Are they prescribed medications, have they been compliant, do they need refills, never seen a psychiatrist? Sometimes psychiatric medications lose their effectiveness. Some take as long as 4 weeks to take effect. Find out if the individual is taking their medications as prescribed or if they feel they may be suffering side effects.
- Are they abusing drugs or alcohol? Do they have a history of abuse, are they using now? If an individual is abusing drugs/alcohol the individual does not have the capacity to make rational decisions. When you mix in suicidal thoughts the situation becomes even more dangerous. For this reason anyone who is having suicidal thoughts and currently abusing drugs/alcohol is highly encouraged to seek hospitalization.
A person experiencing homicidal thoughts toward another person would be considered to be in a psychiatric emergency as well.
The individual doesn’t even have to have a target for homicide in mind to be considered a “threat to self or others”.
Some who abuse drugs or experience hallucinations have general homicidal thoughts; this means that anyone they encounter in public could potentially be a target. If anyone talks of homicidal thoughts whether there is a specific target or not is worthy of immediate hospitalization.
Helping individuals with homicidal thoughts presents a far greater challenge than assisting someone with suicidal thoughts who only wants to hurt themselves.
Determining the next course of action with someone experiencing homicidal thoughts requires almost the same questions for someone with suicidal thoughts.
- Is there a specific target? Does the individual want to hurt a family member, co-worker, is there even a target. It’s important to learn about potential targets of violence to help keep them protected. HIPPA law protects medical professionals who reveal this information to law enforcement or family members for safety reasons.
- Is there a timeframe?
- Do they have means to hurt someone else? Do they own a weapon, are the physically overpowering?
- Is there anyone supportive? Can family member or friend safely reason with the individual?
- Is there a history of violence or a criminal record? This is a good indicator of the likelihood of the individual harming someone else.
- Are they taking psychiatric medications?
- Are they currently using drugs or alcohol?
All of these questions help determine if hospitalization is needed, however every situation is different which is why the best way to gauge whether a situation is emergent is if the person is a threat to themselves or others.
Psychosis is a mental health disorder that causes impaired thoughts and judgments where the individual loses contact with external reality.
Two of the most common causes of psychosis are auditory hallucinations and visual hallucinations.
An individual can suffer from psychosis and lack both suicidal or homicidal thoughts. This person could pose no direct threat to himself or others however still meet the criteria for a psychiatric crisis. Although a person suffering from psychosis may be no threat to others, their unfamiliar actions may cause strangers to physically act out against them.
Individuals suffering from auditory hallucinations hear voices or sounds that may not exist is the external reality, however to the person they are very real. Examples of auditory hallucinations include:
- Hearing voices. Sometimes the voices are familiar and sometimes they are demonic. If an individual is hearing voices it’s important to ask if the person can make out what they are saying. Sometimes voices encourage patients to harm themselves, others or simply make disparaging remarks. Here is a YouTube video of a representation of auditory hallucinations.
- Mumbled voices. Other times individuals hear voices although they cannot make out the words being spoken.
- Sometimes individuals constant loops of their favorite songs, TV commercials or other sounds.
Visual Hallucinations involve a person seeing things that do not exist.
Here are some examples of visual hallucinations:
- Seeing shadowy figures
- Flashing lights
- A person’s image changing in the mirror
- An altered headline in magazines or newspapers
- Demonic figures
Suffering from either of the aforementioned conditions can be scary which is why it’s important to provide nonjudgmental support.
Here are ways to provide support to someone experiencing hallucinations:
- Ask about a potential diagnosis (schizophrenia, schizoaffective disorder)? if they have been taking their medications are prescribed.
- Find out if they have been taking medications are prescribed.
- Speak to them quietly about what’s going on
- Ask them to explain what’s going on and if this is confusing or frightening.
- Don’t deny their hallucination. You shouldn’t agree either, but you want to simply show support to them and what they are going through.
- Ask if there is anything you can do to help. Offer help contacting their doctor or helping them get to a nearby hospital.
If your attempt at support does not help the individual to overcome the anxiety and fear caused by hallucinations the next options would be hospitalization if they are willing.
Side Effects To Psychiatric Medications
The last psychiatric emergency we’ll discuss deals with side effects to psychiatric medications.
Some psychiatric medications take days or weeks to improve your mental health. Some medications never workout. The way your body responds to medications can differ from your neighbor. Because of this, it’s important that you are mindful of any psychiatric side effects. If you believe you are experiencing side effects, don’t panic but instead immediately report them to your doctor and wait for further instructions.
Note: For a listing of potential psychiatric side effects click HERE. If you are taking or plan to take psychiatric medications to review the link above to familiarize yourself with common psychiatric side effects.
If you cannot reach your psychiatrist or your experiencing side effects after hours it’s important that you visit the nearest ER, NOT a psychiatric hospital.
For chest pains, rapid heart rate, nonstop vomiting or difficulties breathing you want to either visit an ER or call 911. A psychiatric hospital is capable of treating psychiatric problems (depression, anxiety, suicidal thoughts), but medical problems like the ones mentioned earlier are medical issues that can only be treated at an ER.
The easiest way to get help in a psychiatric emergency is if the patient is voluntary.
If a patient or family member is willing to work with you there are more options available and there’s a greater chance the outcome will be positive.
If a patient is experiencing a psychiatric emergency the first thing you should do is comfort the individual. Let them know that everything will work out because you are there for support.
Next, you want to take a genuine interest in learning exactly what the individual is going through. If they’re suffering from suicidal thoughts, ask them why? Ask if they have a history of suicidal thoughts. Ask if they are currently seeing a psychiatrist. If they are seeing a psychiatrist, offer to call their clinic if possible.
If the patient is suffering from auditory hallucinations, again be supportive. Even if the hallucination is far-fetched, continue asking questions like if this makes them scared? What is the hallucination saying? And what can you do to help them out.
If a patient is voluntary you want to keep them that way. There are many instances where voluntary patients, quickly turn into involuntary patients because their concerns weren’t taken seriously or they lost trust in you.
If you can’t come to a resolution, offer to help them get to a psychiatric hospital.
Note: Remember if the patient is suffering from medical problems (trouble breathing, rapid heart rate, chest pains, nonstop vomiting) ONLY a medical ER can treat these problems. Psychiatric hospitals aren’t equipped to handle such emergencies. For medical problems as a result of psychiatric medications contact 911, a medical hospital is the most appropriate follow-up.
There are three ways to get a voluntary patient admitted to a psychiatric hospital:
Drive them yourself
If you feel safe driving someone to a psychiatric hospital this is an option. Be certain that the individual understands the plan, where you’re going, and why you’re going.
Editor’s Note: Neuro Psychiatric Center (NPC), located in the medical center, is main crisis hospital that clients are taken to. NPC isn’t the only crisis hospital, though. Check out our article titled Inpatient Psychiatric Hospitals in Houston for a list of all the options available to you.
If a client is suffering from auditory or visual hallucinations this could present a danger to you and the client. If you feel the client is not fully in control due to hallucinations consider this alternative below.
If you don’t feel safe transporting a client or family member another option is to contact 911.
When you reach 911 dispatch calmly tell them your client’s situation. Inform them that your client is currently or has a history of mental illness although they agree to accept help getting to the nearest psychiatric hospital.
Let dispatch know that there are no weapons, however, if there are lock those away in another room. Although the client is voluntary, police don’t know this. Put yourself in the responding officer’s shoes and consider what would it take to make you feel safe going into an unfamiliar home?
Before ending the call request a Crisis Intervention Team officer. You can call them CIT officers for short. CIT officers are trained at dealing with individuals with mental illness. Once a CIT officer arrives their goal isn’t to arrest or hurt your client, but rather get them help.
Direct the responding officer to the client and introduce the officer to the client and what’s going on. The client will likely be nervous so reassure them that things will work out.
Whether it’s you or 911 transporting, be sure to ask the client to sign a confidentiality form once they arrive at the hospital. HIPPA law prohibits hospitals from confirming or denying that a patient is at their facility. If a client fails to sign this form the spouse, parent or even child won’t have access to their loved one.
Those are the two ways you can help a voluntary client get to a psychiatric hospital. Now we’ll discuss how you can help involuntary patients.
Before telling you how you get help for an involuntary patient let me first warn you; that this can be a difficult process.
As an American citizen, you have God-given rights. Unalienable rights to paraphrase Thomas Jefferson. Freedom to make your own way in life is a beautiful thing for someone of sound mind. For someone struggling with mental illness, those rights can be a nightmare for loved ones.
Believe it or not, it’s not against the law to talk to yourself in public. Or have the belief that you can literally move mountains with your mind. OR believe that President Trump is speaking directly to you through TV interviews. These strange behaviors are all perfectly legal.
It’s only when a person is a threat to themselves or others that someone can be involuntarily committed. Anything short of this no matter how bizarre won’t result in an involuntary commitment.
Here’s another thing to consider about involuntary commitment and your rights:
If involuntary commitment were easy, it’s possible you could be committed. Having trouble with a spouse, a friend or co-worker could result in them contacting 911 and having you committed!
The details of why involuntary commitment is difficult to pull off won’t make your situation any less frustrating, although it’s important to understand the limits of the law. The better you understand the limitations of involuntary commitment, the better chance you have of finding help for your loved one.
Now that we’ve discussed the barriers, let’s talk about practical steps to getting an involuntary commitment.
If a client or friend is exhibiting suicidal or homicidal behaviors it’s your ethical duty to find help.
Before going the involuntary route at least offer assistance. If they deny your help and you think there’s the potential that someone could be hurt it’s time to contact 911.
When contacting 911, try and get some distance between you and the person in crisis. They’ve already made it clear that they don’t want help, so contacting 911 in front of them could make things worse.
When speaking to the 911 dispatcher provide your address and phone number before going into the story. You’ve now given dispatch contact information to follow up within the event that you get disconnected.
Next, explain the situation. Talk about the threat (suicidal, homicidal). Speak about the current plan for violence, psychiatric diagnosis,
Talk about the threat (suicidal, homicidal). Speak about the current plan for violence. Reveal the psychiatric diagnosis. Also, warn dispatch of potential weapons the client has access to. If weapons are nearby try to lock them away. Don’t put yourself in harm’s way, but again try to remove weapons. Before disconnecting, be sure to request a CIT officer. This Houston Police Officer who is trained to handle psychiatric emergencies.
Once you’ve finished speaking to dispatch your goal is to now prevent the client from leaving. Don’t physically block the client but if they try to leave make a plea for them to stay. Depending on the officer they may not patrol the neighborhood searching for the client.
Earlier I mentioned that involuntary commitment is difficult, well here’s another barrier.
If the responding officer arrives and doesn’t notice threatening behavior they won’t be able to commit the client against their will. The responding officer must witness suicidal or homicidal gestures or again they won’t be able to commit.
If any threatening behavior is noticed by the officer in most situations they will commit the client to the nearest psychiatric hospital. Most likely the client will be taken to Neuro-Psychiatric Center (next to Ben Taub) or Harris County Psychiatric Center (S.MacGregor and 288).
Mental Health Warrant
In some instances, the client will compose themself and avoid involuntary commitment. Should this happen you have one more option; the mental health warrant.
A mental health warrant is a court-ordered involuntary commitment. Once a judge makes this ruling police officers will travel to a client’s home to carry out the order. Unlike calling 911, when police officers arrive they will commit the client regardless of if he is a threat or not.
Clients who are picked up for mental health warrants are taken to the Harris County Psychiatric Center. This is also the location that you would file a mental health warrant on a family member or friend. Below is the contact information for Harris County Psychiatric Center’s Court-Ordered Voluntary services:
Harris County Psychiatric Center
2800 South MacGregor Way Houston, TX 77021
Monday thru Friday 8am to 4pm
Psychiatric emergencies are always stressful situations, although the better prepared you are the better your chance of connecting yourself or a loved one to the most appropriate services.
If you need more information regarding psychiatric emergencies contact Harris Center’s crisis line at 713.970.7000. This line is staffed 24-hours a day with crisis counselor who can assist you no matter the situation.
If an individual is showing signs of being a threat to themselves or anyone else skip calling the crisis line and contact 911. Houston Police Department has trained officers (Crisis Intervention Team Officers) who can safely secure and transport individuals to the closest psychiatric hospital.
If you know of anyone caring for an individual with a psychiatric diagnosis or health care providers treating clients with mental illness we encourage you to share this article to educate the community about the resources available.
Nick Bryant is a Counselor with 11 years of experience working in community health. He enjoys concerts, walks with the doggo and wife, mocking Dallas Cowboy fans, and sharing community resources. Jump on the Houston Case Managers email list to receive weekly community resource guides delivered directly to your inbox.