The First Things To Do When You Or Someone You Love Is In Crisis

Psychiatrist and Public Health Administrator
What should you do when a mental health crisis strikes? Dr. Ken Duckworth of the National Alliance on Mental Illness reveals how understanding the patterns of one's illness and creating an action plan can help individuals and families manage – and even prevent – a crisis.
  • Transcript


Ken Duckworth:  If you’re experiencing a mental health crisis, I think the first thing to do is figure out what you need. Right? So, if you’re having trouble with your own safety, you’re really thinking about killing yourself, you need to get help. And you need to see a professional, or you need to go to an emergency room. Not everything can be done on a self-help basis. That said, self-help and self-management have become crucial aspects of helping people do well. So the idea over time is to learn as much as you can by joining groups like the National Alliance on Mental Illness, to educate yourself, to participate in your own care in an active way. And it’s not something like, the doctor is giving you a medicine, it’s all forgotten. You learn about your condition, you learn about the stresses, you learn about what it takes to help you live the best way with it. Once you understand that, the crisis that you’re dealing with is probably known to you, and you should have a framework for how to address future problems. So the key thing about thinking about a crisis is how to get ahead of it, how to learn from prior vulnerabilities, and how to enroll people in your life to help you anticipate it in a way that you can accept their gentle feedback.

When a person doesn’t want help, it generates a tremendous challenge in all the people who care about them. How do you help a person who isn’t particularly motivated? Or how do you deal with a person who feels ashamed of their symptoms? Because when you ask a person, do they need help, the vulnerability that they may feel, the shame that they may feel about knowing that they’re struggling, is one of the things that you’re gonna be battling with. So the first thing I encourage them is to be gentle with themselves. This is not an easy thing you’re trying to take on. Then I encourage people to think of overlapping Venn diagrams. You might see: a psychotic illness, a problem hearing voices, difficulty with functioning, and having trouble getting out of bed. They might see: getting out of bed is a problem, and I wish I had more to do. So I encourage people to ignore battling about their diagnosis or their symptoms, and focus on the things that the other person wants to do. I wish I could get out of bed, and I wish I could do more. By work, by starting with things you can agree upon, and building upon them, that’s typically a good way to get started. You will probably need professional help, though. And professionals deal with this hard topic all the time.

In the Wellness Recovery Action Plan, and with any good caregiver, the purpose of the work is to identify patterns for you that you can anticipate future vulnerabilities. Some patterns repeat themselves. So, if you have depression that occurs in the winter, or if you have bipolar episodes in the context of relationship distress, these become predictable phenomena. The idea of creating an anticipation of your risk for crisis is actually part of the answer to dealing with a crisis. So the idea would be to understand, if it’s seasonality, relationship changes, medication changes, that are risks for you, and then to identify a series of things that you can do to minimize your risk. Is it aerobic exercise? Is it having a social role? Is it participating in helping other people as a peer and giving yourself a sense of meaning? These are the things that we find over and over help people contend with reducing their vulnerability. So the earlier a person gets help, the better their chances become. People can recover and live great lives.

One place to get help is the NAMI helpline. The NAMI helpline is staffed by people who are living with mental illnesses successfully and by their family members. The number is 1-800-950-NAMI.