Fear about what will happen prevents people from contacting crisis services, and the reality is generally less dramatic than the fear.
The routes
Crisis telephone lines, crisis teams, emergency departments and, in some areas, walk-in crisis services.
Which vary by area, and knowing the local arrangement in advance is useful.
Text-based crisis services exist in several countries for people who cannot or do not want to speak.
The assessment
A conversation about what is happening, how you are feeling, what has led to this and what would help.
Which includes questions about thoughts of harming yourself and about any plans or means.
These questions are asked directly because vagueness helps nobody, and honest answers produce a better response.
What generally happens
Most crisis contacts do not result in admission.
Which is contrary to the common fear, and the usual outcome is a plan for support in the community.
That can include home treatment team involvement, more frequent contact, medication review or a safety plan.
Safety planning
A written plan identifying warning signs, coping strategies, people to contact and how to make the environment safer.
Which has evidence for reducing subsequent harm.
Making it collaboratively rather than having it imposed is what makes it usable.
Admission
Where risk cannot be managed in the community, admission may be offered voluntarily.
Which most people can decline, and the circumstances in which admission can be compulsory are defined in legislation.
Those criteria are specific and generally require both a mental disorder and risk that cannot be addressed otherwise.
Rights to appeal, to advocacy and to review exist and should be explained.
Emergency departments
Frequently the route when nothing else is available, and widely acknowledged as poorly suited.
Which means long waits in an environment that is stimulating and unprivate.
Bringing someone with you, or something to occupy the wait, makes it more bearable. Liaison psychiatry services exist in many hospitals to provide assessment.
Afterwards
Follow-up contact should be arranged, and the period after a crisis contact carries elevated risk.
Which is why follow-up within a short period is a standard in several systems.
If you are in crisis now, contact your local crisis line or emergency services — that is precisely what they exist for, and using them is not an overreaction.
Crisis houses and safe havens
Alternatives to hospital admission providing a place to stay or somewhere to go during a crisis.
Which exist in some areas and are consistently well received where available.
They are generally less clinical in atmosphere and are staffed to provide support rather than treatment.
Supporting someone else
Staying with them, removing means where possible, and helping them contact services.
Which is what guidance for family and friends generally advises.
Asking directly about suicidal thoughts does not increase risk, which is a persistent misconception that prevents people from asking.
Advance statements
Documents recording preferences about treatment during a crisis, made while well.
Which can cover preferred medications, things that help, things that make matters worse, and who should be contacted.
They are increasingly used and are more effective where the service holds a copy.
Repeat attendance
People who contact crisis services frequently are sometimes treated less well as a result.
Which is documented and is contrary to the evidence, since repeated crisis contact is associated with elevated risk rather than reduced.
Care plans agreed in advance with the service can improve the response.
The immediate
Crisis lines, emergency services and, in several countries, dedicated three-digit mental health crisis numbers.
Which are staffed continuously and are the right call at any hour.
Police involvement
Police have powers in several jurisdictions to remove someone in mental health crisis from a public place to a place of safety.
Which is intended as a protective measure and is experienced by many as criminalising.
Reducing police involvement in mental health crisis has been a policy objective in several countries, with mixed progress.
Substance use and crisis
Intoxication complicates assessment and is sometimes used as a reason to defer it.
Which is a documented problem, since risk does not wait for sobriety.
Guidance generally requires assessment rather than exclusion, and this is inconsistently applied.
Discharge from crisis care
The transition back to routine services is a recognised risk point.
Which is why follow-up standards exist specifying contact within days.
Knowing who to contact, and having that written down, is the practical safeguard.
Preparing in advance
Saving the local crisis number before a crisis is a small step that makes a real difference.
Which is difficult to do at the point it is needed.
Writing down what has helped previously, and who to contact, is worth doing while well.
Right now
If you are in crisis, contact your crisis line or emergency services.
Which is what they exist for, and it is not an overreaction.