How to Help a Loved One in a Mental Health Crisis

If you’re loved one is sending signals of a crisis, insist that he or she is “a danger to himself or others.” Here's what you should know.

For about a decade, my dearest love was a man I’ll call Hans, who became a suicidal alcoholic. His illness crept up slowly, but in the last year of his life he didn’t leave his apartment. I was in touch with his psychiatrist and spoke to Hans every day, though he kept refusing to have me visit and sometimes missed his psychiatry appointments.

Hans endearingly had the ability to sound kind and engaged with me, despite his own decline. When he began to seem remote, I knew a shift had occurred. One Sunday, against his wishes, I traveled to see Hans (about a 45-minute trip by subway in New York City) and he didn’t answer the doorbell. I left a note with his superintendent, who had his keys, asking him to go in.

When I got Hans on the phone that evening, he was too weak to speak. He was touched I’d tried to see him and said “goodbye.” “You’re going to die if this goes on,” I said. “Goodbye,” he said. I called his psychiatrist immediately and left a phone message saying, “I think he said a last goodbye to me. Please get him into the hospital.”

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This is a cautionary tale: I learned later that the superintendent knocked on the door and left when Hans told him to go away. His psychiatrist tried to reach Hans by phone for four days. I kept calling the psychiatrist and Hans and getting answering machines. On Friday, the psychiatrist finally called to tell me that the police had entered Hans’ apartment that morning and discovered him dead.

Hans fell through the cracks in a mental health system riddled with cracks.

Sometimes mental health crises come as a complete surprise to family and friends. But if you are in touch with someone who you know is struggling, prepare in advance.  

What’s the first thing you would do to get help? You might check the listings online at the Substance Abuse and Mental Health Services Administration (SAMHA).

Should you run into a crisis, a hospital ER may not be your best choice. The waits are long and the psychiatric services limited.

If you can, locate a psychiatrist you trust. It can be very hard to get a psychiatric appointment, so don’t procrastinate. Start calling and book as early as you see a potential need. If you have guns in the house, keep them locked up and unloaded. Keep dangerous medications out of reach, too.

When you’re caring for someone in crisis who lives alone, as Hans did, take precautions early on while he’s still cooperative, even if it seems overly dramatic at the time. Things can deteriorate quickly. Remove guns and unnecessary dangerous medications. Get a set of keys.

Learn as much as you can about the illness and know the danger signs. There are a number of myths about suicide, for example, that will lead you astray.

One myth is that a person who talks about suicide just wants attention and isn’t serious. Don’t count on it. Take it seriously if you hear someone talk about having no reason to live, being a burden to others, feeling trapped, or experiencing unbearable pain.

You’re right to be alarmed if someone you care about is giving away possessions, visiting or calling people to say goodbye, withdrawing from activities, shutting out family and friends, or acting recklessly or aggressively.

Alcohol is estimated to be a factor in at least 25 to 30 percent of all suicides. If you suspect the person is drinking, move mountains not to leave this person alone.

When should you call 911 or take someone to a psychiatric facility or emergency room yourself? If you can, say, “He’s an immediate danger to himself or others.”

I had done some of the necessary steps. I was in touch with a psychiatrist and told him when I sensed an emergency. I’d alerted the super who had his keys. But I didn’t say the magic words, “He’s an immediate danger to himself or others.”

Many people told me later that I had to say those words to the psychiatrist or call 911 and say them myself. I also didn’t insist on having his keys.

Take fast action if you see people showing signs of psychosis that affect their functioning — delusions, or intense fear, extreme agitation, and an inability to sit still or sleep. Behavior changes that come out of nowhere could be a sign of self-poisoning.

Handling a mental health crisis will wear you down, sometimes in unpredictable ways. I am frugal. I entered a strange mental state on the day Hans wouldn’t let me in his apartment. On my way home, I stopped to buy a pair of $300 shoes. No, I couldn’t afford them. I mostly wear sneakers and rubber sandals. I did other strange things, too.

Get support from family, friends, or support groups. Mental health crises aren’t rare. More than 16 percent of American youth ages 12 to 17 report suffering from at least one major depressive episode in the past year, and many more don’t confess.

Over half of adults with a mental illness are not receiving treatment. You may already know someone who suffered a depression or has seen someone close go through one.

Don’t be passive and trust that your adult loved ones will seek the help they need — sadly, it’s just not true. Many people with severe mental illness don’t recognize that they have a problem and may resist treatment or medication. Most people with alcohol and drug problems don’t get treated, either.

Don’t assume someone else will intervene. It may not be obvious who needs to step up. Hans had a college-age son and an ex-wife who lived nearby. But I knew he was more in touch with me. Clear up this kind of confusion well in advance. You also can’t trust medical professionals to act quickly or decisively unless you push. You need to be the advocate.

Persist — antipsychotics and mood stabilizers dramatically cut the chances that your loved one will commit violence.

After Hans’ death, many people said to me, “There was nothing you could do if he really wanted to die.” This didn’t comfort me. It also isn’t true. Hans died because the psychiatrist didn’t believe my warning was an emergency, and I didn’t call 911. I also hadn’t educated myself to know the magic words. I didn’t have his keys.

You’ll also hear the variation, “You can’t save someone. Don’t push, don’t go against their will.” My experience has taught me the opposite. Statistics and my gut tell me that if anyone, including me, had been pushier, Hans would be alive today. He might well be thriving. Most suicidal people get better. Even among people who have been hospitalized because they were suicidal, according to one estimate, less than 9 percent actually die by suicide. The vast majority are saved, by another person.

You can save someone. It happens all the time. In fact, when someone is sick enough, only someone else can save them.

Remember the words, “He’s an immediate danger to himself or others.” Don’t let your loved one commit violence against himself — or others. That’s one news story in which you never want to read your name. 

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