When a Loved One Is in a Mental Health Crisis: A Family Guide

Few things are as frightening as watching someone you love in a mental health crisis. Maybe a family member with bipolar disorder has not slept in days and is making reckless decisions. Maybe a relative with psychosis is terrified of something no one else can see. Maybe someone has said they do not want to be alive.

In those moments, it is hard to think clearly. This guide is meant to help families prepare ahead of time, respond more calmly in the moment and plan for what comes after.

If someone is in immediate danger right now, call 911 or go to the nearest emergency room. For crisis support, call or text 988 to reach the 988 Suicide & Crisis Lifeline. 988 also helps people who are worried about someone else.

Before a crisis: prepare when things are calm

The best time to plan for a crisis is when no one is in one. If your loved one is willing, plan together. Their input makes the plan more likely to work and more respectful of their wishes.

Create an information sheet

Responders and clinicians often need information quickly. A one-page sheet can help. Consider including:

• Full name, date of birth and any diagnoses
• Current medications and doses, plus allergies
• Names and contact information for psychiatric providers, therapists and primary care
• Past hospitalizations or crisis episodes, and what helped
• Early warning signs specific to your loved one
• Things that tend to calm them down, and things that make situations worse
• Any history of substance use that is relevant

Keep copies where you can grab them, and save a photo on your phone.

Talk about warning signs and preferences

Ask your loved one what they notice when they start to struggle, and how they want you to respond. Some people want a direct conversation. Others want space, then a check-in. Agreeing in advance can reduce conflict later.

Sort out permissions

Privacy rules generally require a patient's permission before providers can share information with family. If your loved one agrees, they can sign a release with their care team. This can make it easier to communicate during and after a crisis.

Make the home safer

Reducing access to firearms, stockpiled medications and other means of harm is one of the most protective steps a household can take. If possible, store firearms outside the home or locked and unloaded with the key held by someone else, and keep medications secured.

During a crisis: what to do

Stay as calm as you can

Your tone can influence the situation. Speak slowly and simply. Lower the volume of the room. Give the person physical space and avoid crowding them.

Listen more than you talk

Acknowledge their feelings without arguing about details: "I can see how scared you are. I'm here." You do not need to agree with beliefs that do not match reality, but debating them usually escalates things.

Ask directly about suicide

If you are worried, ask clearly: "Are you thinking about killing yourself?" Asking does not put the idea in someone's head. It opens the door to getting help.

Decide which help to call

• Call or text 988 when someone is in emotional distress, having suicidal thoughts without immediate danger, or you need guidance on what to do. Trained crisis counselors can talk with the person, talk with you, and help connect to local crisis resources.
• Call 911 or go to the nearest emergency room if anyone is in immediate danger: a suicide attempt has happened or seems imminent, someone has a weapon, there is a threat of violence, or a person cannot keep themselves safe or meet basic needs.

When calling 911, tell the dispatcher it is a mental health emergency. Describe what is happening, whether there are weapons, and any diagnoses that may help responders understand the situation. You can ask whether responders with mental health crisis training are available in your area.

Keep yourself safe too

If you feel threatened, leave and call for help. Your safety matters. You cannot help your loved one if you are hurt.

Bring your information sheet

If your loved one goes to an emergency room or is seen by a crisis team, share your information sheet. Even if staff cannot tell you about the person's care without permission, they can usually receive information from you.

After a crisis: the next steps matter

The period after a crisis, especially after an emergency room visit or hospital stay, is a time when people often need close support. Some ways to help:

• Make sure follow-up care is scheduled. Ask the discharge team about next appointments, and help your loved one keep them.
• Get prescriptions filled and help with any changes to the medication routine if your loved one wants that support.
• Keep the home safe. Continue limiting access to means of harm for a while.
• Watch for returning warning signs and stay in contact with the care team.
• Debrief when things are calmer. Talk about what helped and what you would do differently, and update your plan.

Some people step down from the hospital into a more structured outpatient option, such as an intensive outpatient program, before returning to regular appointments. The care team can help decide what level of support fits.

Taking care of yourself afterward

Crises are hard on families. You may feel shaken, angry, guilty or numb for days or weeks. These reactions are understandable. Rest when you can, talk with someone you trust, and consider support for yourself, such as a family support group or your own therapist.

Ongoing care in Ohio

SOS Wellness is an outpatient practice. We do not provide emergency or after-hours crisis services, so 988 and 911 are the right resources during a crisis. After a crisis, our team can provide psychiatric evaluation, medication management, therapy, intensive outpatient programs and case management to help with follow-up care. Appointments are available at our Middletown and Norwood offices and by telehealth for people located in Ohio.

If your family is looking for follow-up care after a crisis, or wants to put a plan in place before one happens, you can contact us or request an appointment to talk about next steps.