How To Help Someone In Crisis

Sometimes depression and bipolar disorder have symptoms that can best be helped by inpatient psychiatric treatment. Try to find out what treatment is available to your loved one, and what steps you can take during a crisis before the crisis occurs, if possible.

People may need to go to the hospital if they:

• Threaten or try to take their lives or hurt themselves or others
• See or hear things (hallucinations)
• Believe things that aren’t true (delusions)
• Need special treatments such as electroconvulsive therapy
• Have problems with alcohol or substances
• Have not eaten or slept for several days
• Are unable to care for themselves or their families, e.g., getting out of bed, bathing, dressing
• Have tried treatment with therapy, medication and support and still have a lot of trouble with symptoms
• Need to make a significant switch in treatment or medication under the close supervision of their doctor
• Have any symptom of mania or depression that significantly interferes with life

Voluntary hospitalization takes place when a person willingly signs forms agreeing to be treated in the hospital. A person who signs in voluntarily may also ask to leave. This request should be made in writing. The hospital must release people who make requests within a period of time (two to seven days, depending on state laws), unless they are a danger to themselves or others.

Most psychiatric hospital stays are from five to ten days. There are also longer residential rehabilitation programs for alcohol or substance abuse, eating disorders or other issues that require long-term treatment.

Involuntary hospitalization is a last resort when someone’s symptoms have become so severe that they will not listen to others or accept help. You may need to involve your loved one’s doctor, the police or lawyers.

Involuntary hospitalization is an option of last resort only. It is better to talk with your loved one before a crisis and determine the best treatment options together. Work with your loved one in advance to write down ways to cope and what to do if symptoms become severe. Having a plan can ease the stress on you and your loved one, and ensure that the appropriate care is given.

How can I convince my loved one to check in voluntarily?

• Explain that the person is not going to an institution, asylum or prison. Hospitalization is treatment, not punishment.
• Reassure your loved one that the hospital is a safe place where a person can begin to get well. No one outside the family needs to be told about the hospitalization.
• Tell your loved one that getting help does not mean someone has failed. A mood disorder is an illness that needs treatment, like diabetes or heart disease. Hospitalization is nothing to be ashamed of.
• Call the hospital and find out more about admission, treatment and policies.
• Help your loved one pack comfortable clothing and safe items that are reminders of home.
• Offer the person a chance to make choices (such as what to take to the hospital, or who to go with), if this is desired.

How should I talk to a person in crisis?

• Stay calm. Talk slowly and use reassuring tones.
• Realize you may have trouble communicating with your loved one. Ask simple questions. Repeat them if necessary, using the same words each time.
• Don’t take your loved one’s actions or hurtful words personally.
• Say, “I’m here. I care. I want to help. How can I help you?”
• Don’t say, “Snap out of it,” “Get over it,” or “Stop acting crazy.”
• Don’t handle the crisis alone. Call family, friends, neighbors, people from your place of worship or people from a local support group to help you.
• Don’t threaten to call 911 unless you intend to. When you call 911, police and/or an ambulance are likely to come to your house. This may make your loved one more upset, so use 911 only when you or someone else is in immediate danger.  

Crisis Planning

Some people find it helpful to write down mania prevention and suicide prevention plans, and give copies to trusted friends and relatives. These plans should include:

• A list of symptoms that might be signs the person is becoming manic or suicidal.
• Things you or others can do to help when you see these symptoms.
• A list of helpful phone numbers, including health care providers, family members, friends and a suicide crisis line such as 1-800-273-TALK.
• A promise from your friend or family member that he or she will call you, other trusted friends or relatives, one of his or her doctors, a crisis line or a hospital when manic or depressive symptoms become severe.
• Encouraging words such as “My life is valuable and worthwhile, even if it doesn’t feel that way right now.” “Reality checks” such as, “I should not make major life decisions when my thoughts are racing and I’m feeling ‘on top of the world’. I need to stop and take time to discuss these things with others before going through with them.” 

How can an advance directive or a medical power of attorney help?

An advance directive and a medical power of attorney are written documents that give others authority to act on a person’s behalf when that person is ill. Your loved one can specify what decisions should be made and when. It is best to consult a qualified attorney to help with an advance directive or a medical power of attorney. These documents work differently in different states. The resources below can give you more information.

• National Association of Protection and Advocacy
  (202) 408-9514
  www.napas.org
• Treatment Advocacy Center
  (703) 294-6001
  www.psychlaws.org

How long will it take before the person feels better?

Some people are able to stabilize quickly after starting treatment; others take longer and need to try several treatments, medications or medication combinations before they feel better. Talk therapy can be helpful for managing symptoms during this time.
If your friend or family member is facing treatment challenges, the person needs your support and patience more than ever. Education can help you both find out all the options that are available and decide whether a second opinion is needed. Help your loved one to take medication as prescribed, and don’t assume the person isn’t following the treatment plan just because he or she isn’t feeling 100% better.

There is hope!

As a friend or family member of someone who is coping with bipolar disorder or depression, your support is an important part of working toward wellness. Don’t give up hope. Treatment for mood disorders does work, and the majority of people with mood disorders can return to stable and productive lives. Keep working with your loved one and his or her health care providers to find treatments that work, and keep reminding your loved one that you are there for support.