Knowing the Difference Can Save a Life
There is a moment that many families remember forever — the moment they realized things had gone from hard to dangerous. Sometimes it is a phone call. Sometimes it is a text message that does not feel right. Sometimes it is a feeling that builds over weeks until you cannot ignore it anymore.
Mental health struggles exist on a spectrum. Most of the time, what someone is going through is serious but not an emergency. But sometimes it is a crisis, and in those moments, knowing what to do — and doing it quickly — can make all the difference.
This guide is about recognizing the signs that a mental health situation has become a crisis and knowing what to do when it does.
What Counts as a Mental Health Crisis?
A mental health crisis is any situation in which a person's thoughts, feelings, or behaviors put them or someone else at risk of serious harm. It is not about being sad, anxious, or overwhelmed — those are real and deserve support, but they are not the same as a crisis.
A crisis is when safety is in question. The two most common types are:
- A suicidal crisis: A person is thinking about, planning, or attempting to end their life.
- A mental health emergency: A person is experiencing severe symptoms — such as psychosis, extreme agitation, or an inability to care for themselves — that put them at immediate risk.
Signs That Someone May Be in a Suicidal Crisis
Warning signs are not always obvious, and they look different for everyone. But some common signs include:
- Talking about death or suicide. This might be direct ("I do not want to be here anymore") or indirect ("I would not be a burden if I were gone"). Take all of it seriously.
- Giving away possessions. Especially things that matter to them.
- Saying goodbye. Unusual calls or messages to people they care about.
- Withdrawing from everyone. Pulling away from friends, family, and activities they used to enjoy.
- Sudden calm after a period of distress. This can be a sign that someone has made a decision, not that they are feeling better.
- Risky or reckless behavior. Acting as if they do not care what happens to them.
- Expressing hopelessness. Feeling like things will never get better, like they are a burden, or like there is no way out.
- Looking for means. Searching for or acquiring things that could be used to hurt themselves.
Signs of a Mental Health Emergency (Not Necessarily Suicidal)
A person may be in crisis without being suicidal. Signs include:
- Severe confusion or disorientation. Not knowing where they are, what time it is, or who people are.
- Hallucinations or delusions. Seeing or hearing things that are not there, or firmly believing things that are not true.
- Extreme agitation or aggression. Unable to calm down, or behaving in ways that could hurt themselves or others.
- Inability to care for basic needs. Not eating, drinking, or caring for themselves to a degree that puts their health at risk.
- Severe self-neglect. A sudden and dramatic drop in functioning.
What to Do in the Moment
If you believe someone is in crisis, here is what to do:
1. Ask directly
If you are worried someone is thinking about suicide, ask them directly: "Are you thinking about suicide?" or "Are you thinking about ending your life?"
This is hard. Many people are afraid that asking will put the idea in someone's head. It will not. Research shows that asking directly does not increase suicidal thoughts — it gives the person permission to be honest, and honesty is what you need to keep them safe.
2. Listen without judgment
If they say yes, do not panic, do not argue, and do not lecture. Say something like, "I am glad you told me. I want to help you stay safe." Let them talk. Your job right now is not to fix it — it is to keep them safe and get them connected to help.
3. Call for help
You do not have to handle this alone.
- Call or text 988. The 988 Suicide & Crisis Lifeline is free, confidential, and available 24/7. You can call for yourself or for someone you are worried about. They can talk you through what to do and connect you with local resources.
- Text 741741. The Crisis Text Line provides free, confidential text-based support.
- Call 911 if there is immediate danger. If someone has already hurt themselves, has a weapon, or you cannot keep them safe, call 911. When you call, tell them it is a mental health crisis and ask for a crisis intervention team (CIT) if one is available.
4. Stay with them
If you can, do not leave them alone. Your presence matters. You do not have to say the perfect thing — just being there, staying calm, and keeping them connected to help is enough.
5. Remove means if you safely can
If there are items that could be used to hurt themselves (medications, weapons, etc.) and you can safely remove or secure them, do so. Do not put yourself in danger.
What Not to Do
- Do not promise to keep it a secret. If someone is in danger, their safety comes before their privacy. You can say, "I care about you too much to keep this to myself. I need to get you help."
- Do not argue or try to guilt them. "Think about your family" or "You have so much to live for" can make someone feel worse, not better.
- Do not leave them alone if you can stay. If you absolutely must leave, make sure someone else is with them or that they are connected to help first.
- Do not assume it is just attention-seeking. Take every sign seriously. It is always better to overreact to a false alarm than to underreact to a real crisis.
After the Immediate Crisis
A crisis is not over when the moment passes. The person will need ongoing support. Help them:
- Follow up with a professional. A therapist, psychiatrist, or their primary care doctor.
- Make a safety plan. A mental health professional can help create a plan for what to do if things get bad again.
- Stay connected. Check in regularly in the days and weeks that follow. The period after a crisis can be particularly vulnerable.
- Take care of yourself. Supporting someone through a crisis is traumatic. You deserve support too.
A Personal Note
I know what it is like to be on the other side of this — to be the family member who is afraid, who does not know what to do, who wishes they had understood the signs sooner. If you are reading this because you are worried about someone right now, please call 988. They can help you figure out what to do. You do not have to carry this alone.
This article is for general informational purposes only and is not a substitute for professional advice or emergency care. If you or someone you know is in crisis right now, call or text 988 (the Suicide & Crisis Lifeline) any time, day or night. In an immediate emergency, call 911.