I’m in Crisis

Recognizing when you need help is an important first step towards getting the crisis support you need. You don’t have to wait until things get really bad to get help. If your thoughts, feelings, or actions feel hard to handle, there are people who can support you.

If you’re:

• feeling desperate and or hopeless
• worried you might hurt yourself or someone else, or commit suicide
• alone with no one to talk to

If you have:

• made a plan
• the means to hurt yourself or someone else (e.g. pills or a weapon)
• attempted suicide or hurt yourself before

These signs are serious and require immediate mental health support. Please get crisis help immediately by doing one of the following:

• Call 911
• Go the nearest Emergency Hospital
• Call the local Emergency Response Service

If you need to talk to someone, but are not in crisis, check out other ways that you can get help!

When you call 911, tell them exactly where you are calling from so they can come and talk to you. You can also let the dispatcher know if you’re going through a mental health crisis. This way, the responders can come ready to help and handle the situation calmly.

Remember that you are doing the right thing by reaching out for help. You deserve to feel better and get the help you need.

Even if you have already harmed yourself, it’s not too late to turn this around.

You will get through this crisis situation.

Keep talking to 911 while you wait for help to arrive.

If you’re feeling overwhelmed or unsure of where to turn, reaching out to a crisis line can provide immediate support and guidance. Crisis lines are there to listen, support you, and help with mental health or thoughts of suicide without needing a hospital visit.

Benefits of Calling a Crisis Line

Talking to someone at a crisis line will:

• help to calm you down
• give you some perspective
• help you assess your situation
• help you figure out your options and next steps
• You can call a crisis line any time, for any reason.
• Crisis centres will point you to helpful resources in your community (including doctors, counselors or therapists). They may even help you set up initial appointments.
• Depending on where you live, some crisis centres have teams that will come to your home if it’s right for your situation.
• Once a crisis worker assesses your situation, he or she may help you create a safety plan to use while you wait for your first appointment (or any other time you need help).

Why Call a Crisis Line?

Some reasons people have called crisis lines in the past include:

• Feeling depressed for a week or longer.
• Experiencing things that may be unreal or bizarre (seeing, hearing or smelling things, and questioning whether others have the same experience).
• Experiencing anxiety attacks and looking for ways to cope.
• Having frightening thoughts of suicide or violence, without any plans to carry it out. Remember, if you have made plans, call 911 immediately.
• The signs of depression become worse, including more or less sleep, over- or under-eating, poor concentration, no energy, no motivation, not doing well at school or work, isolating self, feeling no one understands or cares.
• Needing information about other support services in the community.
• A friend or family member is in emotional trouble and wants support and direction.

Here are some crisis support numbers you can call.

The decision to go to the emergency room (ER) can be overwhelming and frustrating. That is the bad news. The good news is that with their help, you will get better. Emergency rooms can help right away if someone is in a mental health crisis. They check your safety, keep you stable for a short time, and make sure you’re not at risk of hurting yourself or others. You will gain control through increased understanding, more coping tools, and the knowledge that you are not alone. It’s not an easy step, but it can be your first step to regaining control of your life.

When to Go to the Hospital

Some reasons people have gone to the hospital for crisis support include:

• They have injured themselves.
• They are seeing, hearing, smelling or feeling things that are bizarre and frightening (and they feel unable to cope with these experiences).
• Hearing voices that tell them to do something dangerous.
• Using heavy substances like drugs or alcohol, or when coming down from drugs or alcohol (which can be a life-threatening situation).
• Experiencing distressing side effects from prescribed medication.
• Having thoughts of hurting themselves or committing suicide, with a plan to do it (or a history of attempts).

If you are experiencing any of the above, get yourself to the hospital.

Ok, so you’ve made the call for help and are now waiting for it to arrive. Waiting for crisis support can feel frightening. These steps are designed to reduce immediate risk and help you stay as safe as possible until help arrives.

Steps to Take While Waiting for Help

If possible, find someone to wait with. If you can’t, try these tips to help calm down during a crisis:

• Find comfort in a pet or stuffed animal.
• Call a friend or crisis line to talk to you until help arrives.

If you’re at home:

• Get out your health card or ID, if you have it, and a purse or backpack.
• Crawl into bed or on the couch and pull the blankets up.
• Pack yourself a bag of essentials you might need at the hospital (e.g. a sweatshirt because sometimes the ER can be cold, a book, your medications, etc.).
• Avoid places where there are things you could hurt yourself with (e.g. the kitchen, bathroom, garage, etc.).

If you are not at home:

• Find a safe space to wait.
• Find a comfortable chair to sit in or a safe place to walk.
• Stay there and stay safe until help arrives.

If you’re too restless to sit still:

• Keep your hands busy with your phone or sort things like coins, playing cards or socks.
• Play Squish ‘Em on your computer or mobile phone.
• Get out a puzzle. Even if you’re just organizing the pieces by colour and size, it will keep you busy and safe.
• Pace back and forth.

Remember to Breathe

Take a deep breath… slow, steady breathing can help calm your body and ease feelings of panic.

It may sound stupid but sometimes, when we’re stressed out, we can hold our breath without realizing it, and that can keep us feeling panicked. Breathe deeply. Breathe in and out.

Focus on this moment. Don’t worry about the next hour or the next day or the next week. Just hold on to breathing in this moment. Let time pass as you hold tight until help arrives.

People at the ER will help you. They will provide support, problem-solving and help in managing a mental health crisis. Above all, they will work to keep you safe. All ER services are confidential and based on your needs. ER support is generally limited to one visit, but they will give you referrals to other community resources. Whenever possible, the ER staff will try to avoid hospitalization.

Before Receiving Support

The ER can be an overwhelming place. You may wait a long time, which can be distressing and frustrating. You’ll talk to nurses, the ER physician and possibly, but not always, the psychiatry team. A crisis nurse may be there to talk to, especially in the evenings. You may also see security guards in the ER, working to ensure the safety of patients and staff.

An Assessment of Your Situation

Questions in ER will focus on the crisis happening now. Nurses will ask about your mood, sleep patterns, appetite, psychiatric history, medications, substance use, family history of mental illness, stressors/supports, past history/childhood factors and legal involvement. They will also need to know whether you’ve had thoughts or suicide attempts, or instances of hurting yourself or others.

Staying in an Interview Rooms

Interview rooms in the ER are sometimes described as institutional and not very comfortable. The goal is for these spaces to manage any crisis situation safely, such as a person who is out of control for different reasons. Keep yourself warm while you wait, and check with your nurse about where to use the phone or find vending machines.

Receiving a Personalized Care Plan

After meeting with the doctor, a plan of care will be set up for you. It lists the formal and informal strategies (worked out by you and the staff) to keep you safe and support your recovery. The care plan might include an appointment for further assessment in a community setting away from the hospital. Hospitalization is usually avoided, unless necessary for safety reasons or for the treatment of severe symptoms.

Managing Symptoms with Medications

You may be given medication in the ER to calm anxiety or panic, to help with sleep, or to clear confused thoughts. These medications usually act fast and address the immediate symptoms. You may take the medication while in the ER, or you may receive a prescription to fill at the pharmacy as soon as possible.

ER doctors don’t usually prescribe long-term treatment medications (i.e. for mood disorders) because they cannot monitor how the medication will work overtime. If you need this kind of monitoring, the ER doctor will refer you to your family doctor as soon as possible. He/she may also make an appointment for you to see a psychiatrist as an outpatient, to assess and monitor your need for medication.

Follow-Up Appointment

ER staff may give you a follow-up appointment with a Crisis Service, so you can work on crisis planning and explore how to get through tough times. Other great community resources may come up at this time. You can always call your local crisis center yourself to ask for a follow-up appointment if you are not offered one while in the ER.

Voluntary or Involuntary Admissions and “Form 1”

The psychiatry team decides whether or not to admit for an in-patient stay. If they think you may benefit from admission, and you are in agreement, then you are considered a “voluntary patient”.

Involuntary status is a special situation where a doctor decides for specific, detailed reasons, that you should be hospitalized even if you don’t agree. In Ontario, a Form 1 is a legal document that explains the doctor’s reasons for admitting you. This type of involuntary admission is valid for 72 hours. Note that this form may have a different name in other provinces.

A Form 1 gets you time and space to make better decisions for yourself. Though involuntary admission can feel like a loss of control it’s a way to keep you safe and help you gain control of your situation.

All patients have legal rights. If you’re an involuntary patient, you have access to the hospital’s Patients’ Rights Advocate to help you understand the legal details of what is happening.