You are at work and a frequent customer tells you that he is experiencing severe depression and is considering suicide. She is at a party and a friend appears to be having a severe panic attack. She is at home and a person outside has been screaming for several hours.
What should you do?
Mental health experts say you start by assessing your level of risk. If the person in distress is someone with whom you are familiar and comfortable, you can listen without judgment and get answers to questions that give you an idea of the potential for impending harm.
If the situation has escalated to the point where there is a threat to the life of the person in distress or to those around them, a crisis level intervention is advanced.
In all situations, experts urge seeking help from a mental health professional rather than attempting to diagnose someone, administer treatment, or administer medication yourself.
The most accessible options for people experiencing mental health problems or helping others are the national mental health helplines, which operate 24 hours a day.
On July 16, a national telephone service, 988, was launched, which people can call for themselves or others experiencing a behavioral or mental health crisis. It is a three-digit national service that replaces local suicide hotlines and other helplines.
Also, while 988 goes live, the local crisis lines for each Washington county are available. Michelle McDaniel, the managing director of Crisis Connections in Washington, said most calls dispatchers receive can be resolved while they’re on the phone.
In life-threatening situations where weapons are involved or someone threatens the safety of themselves or others, experts say calling 911 is imperative.
Many people may be concerned about calling 911 and whether doing so could bring armed officers to the scene, escalate the situation, or put the person at risk of going to jail.
Those concerns are valid, experts say, particularly in our current mental health and crisis care systems, which are under-resourced and heavily reliant on law enforcement.
“The reality is that when an officer approaches with a police car — he’s wearing a uniform, a badge and a gun — that alone can escalate the situation,” McDaniel said. “There’s a higher chance that when a police officer shows up, that situation will escalate, as opposed to if a team of plainclothes mental health professionals shows up in an unmarked vehicle, so that’s a real thing.”
One study found that people with untreated mental illness are 16 times more likely to die during an encounter with police than other people apprehended by law enforcement.
“It’s a challenge,” said Adam Wasserman, state coordinator for Washington 911, acknowledging the difficult decision.
But McDaniel said, if you are concerned about the safety of this person or others, it is not your responsibility as a member of the public to determine whether law enforcement is the appropriate response.
In our current system, sometimes mental health professionals can’t get there that quickly, and they’re usually not armed.
“The alternative to doing nothing is not helping [a la persona en crisis]McDaniel said.
Talk to the operators
When calling emergency services, introduce yourself and describe the person in crisis, including their name, age, and current location.
“The more information, the better,” says Wasserman. More information allows 911 or 988 dispatchers to ensure that the most appropriate response is given.
For example, if you think the person is a threat, explain why. Is this person walking around with a baseball bat, brandishing it at people and yelling at them? Or is she sitting on a park bench looking disoriented?
Depending on the information provided, officers can dispatch law enforcement or a fire rescue team or an emergency service.
While on the phone, you can mention that you think the situation involves a mental health crisis. This can lead to more questions from operators and provide more information to responding agents.
You can also mention your goal: to be helped, not to be stopped or hurt.
In some parts of Washington, dispatchers may send out a designated crisis response (DCR) agent or a mobile crisis team that may work with police officers or EMS. All Washington officers are required to have eight hours of crisis intervention training. You can request that a Crisis Intervention Team (CIT) trained officer, who has received 40 hours of additional mental health training, respond to the situation. About 54% of SPD officers are certified, although there are fewer statewide.
You can mention if the person in crisis has made any direct threats of violence or self-harm or possesses weapons or substances.
Corey Williams, a sergeant with the Seattle Police Department’s Crisis Response Team, said he trusts officers’ discretion on whether someone can be charged with drug possession or another crime while experiencing a mental health crisis.
“If there is a crime of violence against people, I always defend that person has to go to jail, to protect the victim to protect the public,” he said. Courts in King County and elsewhere also have programs that can direct people to mental health and addiction treatment after an arrest.
For people calling for their friends, family or acquaintances, Shaida Hossein, director of mental health education and training for Seattle Jewish Family Services, suggests letting dispatchers know about triggers that could aggravate the situation, such as speaking in loud or approaching too quickly, and suggestions that could avoid tension, such as speaking quietly, having someone you trust close by, or being able to smoke a cigarette while you talk.
Other ideas are to ask the dispatcher, “Can the agents come with their sirens off?” and “Can I approach arriving agents first before they approach my friend?”
Wasserman said dispatchers are also trained to ask questions so the caller doesn’t have to keep a mental list of items to remember.
With emergency rooms near capacity, experts don’t recommend that people go to hospitals for mental health problems as a first resort. Sometimes, depending on the severity of the situation, a person may contact other mental health resources.
However, if a situation involves serious self-harm or harm to others, people should seek immediate help or go to a hospital, said Paul Borghesani, a physician in the psychiatry department at Harborview.
That would include someone not taking their prescribed medication or locking themselves in a room and not eating, compromising their physical health. Also someone who experiences psychosis or has suicidal tendencies. “If there is a security problem, you have to go to the emergency room,” Borghesani said.
The person in crisis may come on their own, be brought by a friend or family member, or be transported by ambulance, although the cost may be charged to insurance and passed on to the individual. Once there, the front desk clerk will triage to the appropriate department.
An ER doctor will ask you a few questions about your physical health and then bring in a social worker for a mental health evaluation. They will also determine if the symptoms are caused by a medical condition, such as an imbalance in potassium or sodium levels or a urinary tract infection.
This can take a while, says Borghesani. “Trying to get people into the hospital, getting insurance clearance, contacting family, getting warranties, talking to the patient to find out what’s wrong, calling around and making referrals… all of this takes literally hours.” “.
If someone is stabilized in the ED, doctors and social workers will assess whether they can go home, or be assigned a follow-up appointment at a community health center, or go to a crisis diversion center or a substance use disorder program.
“Emergency services are not set up for long-term care, but rather to send people elsewhere,” Borghesani said.
Emergency departments aren’t the warmest and most welcoming spaces, either, he said. For example, if you go to the emergency room because you are suicidal, you may be strapped on, though often as a last resort, and have to wait several hours. This is because staff often don’t know you and you may have to make decisions to keep everyone safe.
Family, friends, and people in crisis should understand that even if they come voluntarily, a doctor may determine, after an evaluation, that the person needs to be held, which could become involuntary.