When you call 911, tell them exactly where you are calling from so they can come and talk to you.

Okay, you are in a really bad spot. But coming to this page is good. 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.

Keep talking to 911 while you wait for help to arrive or use the tips in the 'How can I wait for help safely?' section below.

The decision to go to ER can be overwhelming and frustrating. That is the bad news. The good news is that with their help, you can get better. 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.

Some reasons people have gone to the hospital 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 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 of 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.

People at the ER will help you. They will provide support, problem-solving and help in managing a 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.

Waiting to Talk

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.

Assessing your situation

Questions in the 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.

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 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.

Creating a plan of care

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 plan might include an appointment for further assessment in a community setting. Hospitalization is usually avoided, unless necessary for safety reasons or for the treatment of severe symptoms.

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 over time. 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

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.