How can I help my loved one during a psychosis-related crisis?

Please note that NAMI does not operate a crisis hotline. If you or your loved one are in immediate danger, please call or text the 988 Suicide & Crisis Lifeline at 988 (chat function is available here at 988Lifeline.org). NAMI volunteers are not medical or mental health professionals, and we cannot offer medical or mental health advice. The material outlined below is informational and we hope that it provides guidance that results in help.

Seeing someone you care about experiencing a psychosis-related crisis can be frightening. Psychosis is a symptom of a group of serious conditions that affect the mind, where there has been some loss of contact with reality. People living with psychosis experience disruptions to their thoughts and perceptions that make it difficult to recognize what is real and what isn’t. Being prepared for a crisis by learning about resources and support services allows you to act fast and make good decisions. 

Practical tips for getting help in an immediate psychiatric emergency:

Call or text the 988 Suicide & Crisis Lifeline at 988 (chat function is available here at 988Lifeline.org) to speak to a trained mental health crisis worker 24/7. If a local mental health crisis team is available in your community, a mobile crisis team may be able to do an onsite evaluation and provide information about local crisis services.
- To reach the 988 Suicide & Crisis Lifeline for veterans, select "1"
- To reach Nacional de Prevención del Suicidio (Spanish) select "2"
- Lifeline Options for Deaf + Hard of Hearing for TTY Users: use your preferred relay service or dial 711 then 988. You may also text 988, or chat function is available here at 988Lifeline.org.
If a local mental health crisis team is not available in your community, other emergency services will respond. These may include law enforcement officers who have special training in crisis intervention ("CIT" officers) or possibly the first available police officers, who will likely not have crisis intervention or de-escalation training.
Meet emergency responders outside the home and brief them on the situation before they interact with your loved one. Once the police have arrived you will have little control over the situation or what happens.

Practical tips for getting help in an immediate life-threatening psychiatric emergency:

If your loved one or another person is in immediate, life-threatening physical danger, call 911. Be specific that you are calling about a psychiatric crisis.Be clear that you are seeking involuntary psychiatric hospitalization, NOT arrest. “Example: “I am calling about a mental health emergency. My brother has schizophrenia; he is not taking his meds and he is hearing voices.”
Specifically describe the behavior you are seeing that most closely matches the laws in your state for emergency psychiatric hospitalization.
- Example: DON’T say – “My sister is a danger to herself.”
- DO say – “My sister is hearing voices, and she is lying down in the middle of a busy street.”  
Explain why you need assistance. Example: "I'm afraid she will hurt me" or "I can't get her to go to the hospital."
Meet emergency responders outside the home. Brief them on the situation before they interact with your loved one. Once the police have arrived you will have little control over the situation or what happens.

Practical tips for what to do and how to react when there is a threat of assault:

Be aware of the risk. Acute psychosis, especially when accompanied by delusions and substance abuse, can lead to unpredictable behavior.
Minimize substance use. Keep substance use out of your home in whatever ways are possible. Substance abuse can trigger assaultive behavior.
Contact your loved one’s treatment providers. If possible, also inform them in writing; written notification is much more difficult to ignore.
Create a safety plan. Be ready to retreat to a room in your home with a secure lock and a phone.
Use non-threatening body language. Avoid staring at, touching, or standing over your loved one; remain physically distant.
Have a clear exit path. Position yourself so that you can quickly move to safety if necessary.
Safety first. If you are in danger, call 911.

Practical tips for what to do and how to react in a crisis:

Stay calm. Respond calmly and gently; avoid arguing with or confronting a loved one about their beliefs or behaviors. 
Be an ally. A loved one’s thoughts and experiences feel real to them. Help them manage their anxiety and confusion by offering empathy for their feelings. For example: “That must be frightening. I would feel scared, too, if that was happening to me.”  Other options might include: “I’m glad you could talk to me about this, or “I’m glad I could be here to listen today.”
Thoughtful communication. Avoid whispering, joking, or laughing, which may increase agitation and/or trigger paranoia. 
Ask one-part questions. Avoid offering options; choices will increase confusion. Example:
- DON’T say - “Would you rather I called your psychiatrist or your therapist?"
- DO say – “Would you like me to call your psychiatrist?”
Give simple, clear directions. Avoid multi-step instructions; complexity will increase confusion. Example:
- DON’T say – “After we go to the car, we’ll drive to your doctor’s office so she can decide whether to change your medication.”
- DO say – “We’re going to the car now.”
Use teamwork - Avoid arguing with others on the scene; discuss the situation quietly and out of the person’s hearing. 
Visit the Treatment Advocacy Center’s “Respond in a Crisis” web page for more information.

You may find the information contained in the section of NAMI’s website on  Getting Treatment During a Crisis to be particularly helpful.  You may also find NAMI’s Navigating a Mental Health Crisis to be extremely informative. Additionally, the My Mental Health Crisis Plan App lets individuals clearly state treatment preferences, decide who can make decisions on their behalf, and share a crisis plan with doctors and other members of their care team.

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