My husband asked me the other day what the plan should be if I ever have a psychiatric emergency. Until recently, my plan was simply, “Get me to the ER.” Since then I’ve done research and reporting on how that may not be the best option. It turns out, most hospital emergency departments are wildly unequipped to handle anything to do with the brain unless it is physically injured. So my plan became “Get me to Acadia Hospital,” which is the nearest psychiatric hospital. The problem with this answer is that it is too generic. If handling a psychiatric emergency were as easy as handling a broken leg, there would not be so many problems with the process. So, it’s time to come up with a real plan.
There are situations, like attempted suicide, when medical attention is the first priority and a medical emergency room should be the first stop. Psychiatric evaluation only takes place after you are medically stable.
I’m more concerned with psychosis. So far I have never never experienced it, but it’s possible that I will be part of the 58% of bipolar disorder patients who have. Since people experiencing psychosis often do not reach out or even recognize that there is anything wrong, it will be up to those around me to do the leg work. To do that, people have to know what’s happening.
From the National Institute of Mental Health:
- Disorganized thought and speech
- False beliefs that are not based in reality (delusions), especially unfounded fear or suspicion
- Hearing, seeing, or feeling things that are not there (hallucinations)
- Thoughts that “jump” between unrelated topics (disordered thinking)
There are a number of ways these can play out. Expect the unexpected.
How to Help
Just like physical injuries, there is mental health first aid to help while waiting on the pros:
- Be respectful and not judgemental or confrontational.
- Do not lie or make promises.
- Remember that everything they are experiencing is very real to them, even if it’s not to you. Let them talk about it if they want to.
- Let them control the interaction. Ask permission before doing anything.
- Try to de-escalate the situation and remain calm and compliant unless doing so would be unsafe or unreasonable.
- Try to find out if they have had experiences like this before and, if so, what they found helpful.
- Assist them physically and emotionally when seeking professional help.
What if they refuse help?
This is tricky. The level of help they need will depend on the severity of symptoms. Unless they meet the criteria for involuntary committal procedures, you cannot force them to seek treatment. These criteria vary based on location but mostly boil down to whether or not the person is a threat to themselves or others.
It is not often that people experiencing psychosis become violent. However, if you are frightened for your own safety, leave the situation and call for help. Make sure they know you believe the person is experiencing psychosis and describe their behavior in detail, including whether or not they are armed. Some delusions include paranoia of being pursued by authorities. If this is the case, the presence of uniformed officers may escalate the situation.
So, what’s the new plan?
1 Assess the situation: is anything wrong in the first place?
If my behavior is abnormal, but I am not distressed and no one else in the situation is distressed, intervention may not be needed.
2 If small levels of dysfunction or distress are present and it is during working hours, contact mental health providers.
This is a tricky one. My psychiatrist’s office hours are not set in stone and she does not answer calls outside of office hours. So, if there is any doubt, we’ll be skipping this step.
3 If there are high levels of dysfunction or distress, and I am able and willing to accept help, go to the nearest psychiatric emergency room. Call ahead if possible.
Using the suggestions above, he’ll try to get me in the car (back seat, child locks on) and into triage.
4 If I am a danger to myself or others and not willing to accept help, call 911.
Being treated involuntarily usually comes down to a judgement call to make sure everyone gets the help they need whether my treatment or everyone’s safety.
5 Get better
Receiving help as an inpatient or outpatient, I can recover and follow up with my psychiatrist.
Now, things rarely go as planned and there are many factors I may know nothing about, but at least we have a starting point.
Bonus tip: Always carry a list of your medications just in case someone needs to know.
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Image credit: Chiara Cremaschi