Data from the Connecticut Department of Public Health indicates that mental health-related visits to emergency departments have been increasing. In 2021, mental health crises accounted for about 12% of all emergency department visits.
Understanding how to identify a mental health crisis and intervene effectively is crucial for community safety and well-being. This article provides essential information on responding to mental health crises with compassion and efficiency.
What is a mental health crisis?
A mental health crisis is a non-life-threatening situation in which an individual is exhibiting extreme emotional disturbance or behavioral distress. Evidence of a mental health crisis includes:
- Being emotionally distraught, very depressed, angry, anxious, irritable
- Highly erratic or unusual behavior
- Agitated and unable to be calmed
- Talking about threatening behavior
- Talking about harming themselves or others, including suicide
- Self-injury that does not need immediate medical attention
- Disoriented or out of touch with reality
- Paranoid thinking
- Compromised ability to function or not taking care of basic needs (i.e. not eating, not showering, not sleeping, refusing to get out of bed, etc.)
- Alcohol or substance abuse
- Eating disorders
- Not taking prescribed psychiatric medications
Who can I call in a crisis?
911
Direct connection to emergency services; first responders (police and EMS) will respond to the call.
What to say when calling 911
Identify that the person is experiencing a mental health crisis and describe the situation. Request a CIT (Crisis Intervention Team) trained officer if available. Provide as much information as possible about diagnosis, treatment, medications, and any known weapons (guns, knives, edged weapons, screwdrivers, or any object that can cause serious injury).
211
The Connecticut Action Line for individuals 18+ in distress, available 24/7, 365 days a year. Call 211 or 1-800-HOPE-135 (1-800-467-3135) for support, referrals, and connection to local crisis teams. Select prompt #1 to get directed to crisis services. Multilingual staff and interpreters are available if needed. If looking for child/adolescent crisis support, select prompt #1 again after the initial prompt.
Mobile Crisis/CIT
Each LMHA (Local Mental Health Authority) has its own regional crisis line number. Call 211 to be connected to your local crisis line or find it on the DMHAS website. For children up to age 17, there are 4 walk-in urgent crisis centers to receive an immediate response to mental health crises – find these 4 locations at: https://www.mobilecrisisempsct.org/wp-content/uploads/2023/09/Urgent-Crisis-Center-flier.pdf
988
The 988 Suicide & Crisis Lifeline offers 24/7 access to trained crisis counselors for support and referrals to resources. They can provide a warm handoff to mobile crisis and/or emergency services if necessary. Their call center features 4 different modes of communication: calling, text, chatting through their website, and ASL videophone for deaf or hard-of-hearing individuals. To learn more about this resource please visit: https://988lifeline.org
Types of Mobile Crisis Calls
Crisis calls are for individuals who are not in immediate danger to themselves or others. If individuals are highly likely to have risky behaviors, this is considered an emergency and you should call 911 immediately.
Wellness Checks
For individuals who are difficult to contact but have no history of risk behaviors (suicide, aggressiveness, weapons) and show no indication of needing to go to the hospital. Goal is to reconnect/connect to care for better individual support.
Mobile Crisis Without Police
For individuals experiencing increased symptoms who are receptive to assessment/evaluation but unable to leave their home or current location. They must have little to no history of risk behaviors (suicide, aggressiveness, weapons).
Mobile Crisis With Police
For individuals with significant symptom increases, are increasingly agitated (verbally and/or physically), and moderate safety risks (suicide history, violent or aggressive, access to weapons). It’s also fit for individuals who likely need to be transported to a hospital, but are unwilling to go.
What to Do While Waiting for Responders
While waiting for crisis responders, it is recommended to keep your loved one as calm as possible. Informing the person that help is on the way can be beneficial to provide them as much information as possible to avoid any surprise interactions. Continually assess for any safety risks to determine if crisis responders need to change their response approach (e.g., mobile crisis with or without police).
Possible Outcomes of a Crisis Call
If an individual is in grave danger to themselves or others, emergency responders may utilize the following documents.
Emergency Certificate (utilized by LCSW/APRN)
A legal document that allows emergency responders to take an individual, without their consent, to a local emergency department for further evaluation. The certificate requires the individual to be evaluated within 24 hours, and released within 72 hours if not committed to the hospital.
PREE (Police Request for Emergency Evaluation)
Similarly to an Emergency Certificate, this document legally gives police the ability to transport an individual, against their will, to a local emergency department for further evaluation. The same 24 and 72-hour rules apply.
The Red Flag Law
The "Red Flag Law" allows police officers to remove a gun, ammunition, and other deadly weapons from a household when it is determined the owner of the weapon may be a danger to self or others. Family members or medical professionals can petition for a risk protection order to prevent such individuals from acquiring or possessing firearms.
Crisis Intervention Training (CIT)
Crisis Intervention Training is a 5-day program for law enforcement officers to learn how to respond safely to individuals with serious mental illness in crisis. Trained CIT officers can de-escalate situations and link individuals to appropriate treatment. Not all departments have CIT officers, so request one when calling 911 if available.
CABLE
The Connecticut Alliance to Benefit Law Enforcement (CABLE) promotes police-community partnerships and provides specialized mental health training to law enforcement. CABLE’s board includes individuals with lived experience, law enforcement, and mental health professionals committed to its mission. CABLE provides the 40-hour Crisis Intervention training to first responders.
Understanding and effectively intervening in a mental health crisis is essential for the safety and well-being of individuals and the community. Together, we can create a supportive environment that addresses mental health crises with the care and urgency they require.