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WHAT TO DO IN A MENTAL HEALTH CRISIS

Suicide Threat

Samaritans’ at 877-870-4673. Samaritans primary suicide prevention program is the 24 Hour/7 day Telephone Befriending Service offered from two locations in Boston and Framingham. Anyone in need can use the support of Samaritans, which is free, confidential, anonymous, and is accessible any time of the day or night. Samaritan volunteers offer callers uncritical acceptance and respect in a comforting and understanding manner. In addition to supporting depressed, lonely and suicidal callers, this program also supports those calling with concerns for others.

Samariteens at 800-252-8336. Samarteens is a teen help line that provides confidential peer support and understanding to teens who are struggling with feelings of depression, loneliness and stress. From 3 pm to 9 pm on weekdays, and 9 am to 9 pm on weekends, this service is staffed by volunteers between the ages of 15 and 18; outside those hours, calls are answered by adult volunteers.

1. The caregiver should regard this as a serious cry for help.
2. The caregiver should assess the suicidal potential. For example has the person threatened or made attempts at suicide before? What happened? At the time of the threat, were there unusual circumstances or stress in this person’s life? Was the threat used to arouse sympathy from the caregiver or others?
3. Listen to the person as he/she may find the caregiver the easiest person or the only person it is possible to talk to. The caregiver should show the person he/she cares about the person. Listen without making judgments or telling the person how to feel. Do not use statements such as, “You shouldn’t feel that way,” or “You don’t know how lucky you are.”
4. The caregiver should take the person seriously and show this when they speak with him/her. Avoid arguing.
5. The caregiver should talk to the person about suicide. He/she should discuss what suicide means and its finality. By talking the situation through and offering a caring place to discuss the situation the caregiver may sometimes pull the person through the crisis. The caregiver should use a soft voice, speak slowly, and keep responses short and simple.
6. The caregiver should stay at a distance if the person is agitated because he/she may fear any sudden movement or being cornered.
7. The caregiver may have to compromise confidentiality in the interests of possibly saving a life.
8. The caregiver should know emergency telephone numbers, such as emergency services, the police, the person’s mental health treatment team, etc.
9. The caregiver can accompany the person, or see if someone else who is close to the person will accompany him/her to the emergency room if it seems warranted in this situation.

Emergency services or hospital emergency room staff must be alerted if the caregiver knows of any previous suicide attempts; if there is plan for how the suicide will be carried out; and if the caregiver knows what the plan is.

Suicide Attempt

1. Call emergency services immediately.
2. If possible and known, call the person’s mental health treatment team, family (or caregiver).
3. Tell the emergency service personnel if alcohol or any other substance has been taken.
4. Tell the emergency service personnel if the person has any other medical problems and if he/she is on medication for it.

Overdose or Ingesting a Toxic Substance

It is critical to remove the ingested substance as quickly as possible from this person’s system to lessen the chance of permanent injury. If a caregiver is contacted in such an emergency he/she can assist those involved by reporting pertinent information to emergency service personnel. They should be told:
1. What was taken
2. How much was taken
3. What time was it taken
4. The prescribed dosage if the substance was a medication

Highly Agitated or Threatening Behavior

1. The caregiver should protect him/herself and keep a safe distance. He/she should not reach out and attempt to physically touch the person. The caregiver should wait until the person is calmer.
2. The caregiver can work with the person to identify the problem. Is the person responding to hallucinations or delusions? Did someone say or do something that was threatening or was misinterpreted? Is this a reaction to a similar situation in the past that was threatening to the person?
3. The caregiver should use short, simple sentences and a calm, soft delivery.
4. The caregiver should calmly discuss what is happening and the consequences that can occur if the situation escalates (such as the person or others being hurt; loss of trust and respect; the possible intervention of emergency services or the police).
5. If a threat is stated, the caregiver should find out who, when, how and why there is a problem. The caregiver should attempt to soothe the anger felt toward the threatened person(s). He/she should notify the threatened person(s) and, if warranted, emergency services and/or the police.
6. The caregiver should follow up on any concerns or suggestions that were made during this interchange.

If a dangerous object (knife, gun, car, toxic substance, etc.) is part of the threat, the caregiver should make an emergency call to emergency services and the police. If the caregiver has the information, the person’s mental health treatment team should also be contacted.

Total Withdrawal

1. The caregiver should understand that the person can be using this as a protection.
2. The person should not be left alone.
3. The caregiver should reassure the person that he/she is loved and accepted.
4. The caregiver or someone in the person’s family or a friend should sit quietly with the person in a peaceful, secluded place.
5. In attempting to have a conversation, the caregiver/friend should use short, simple, direct phrases to which the person can give brief responses. The caregiver/friend should not be surprised if the person is unable to respond to what is said. The caregiver/friend should not demand a response.
6. The caregiver/friend should contact the appropriate mental health professionals.

Inappropriate Language and Behavior

1. The caregiver should stay calm and neutral.
2. The caregiver should give the person physical and emotional space and not move toward the person.
3. The caregiver should respond only to appropriate language and behavior.
4. The caregiver should tell the person, in a calm friendly, supportive way, that his/her behavior is inappropriate.
5. The caregiver should notify the appropriate mental health professionals.
6. The caregiver should assist the person to a restful place to collect him/herself. The caregiver or someone else should sit quietly with him/her until the crisis has passed. If the situation continues in a crisis mode, the appropriate mental health professional(s) should be contacted.

Caregiver means family member, partner or close friend involved in the life of the person with a mental illness.

Samaritans’ primary suicide prevention program is the 24 Hour/7 day Telephone Befriending Service offered from two locations in Boston and Framingham. Anyone in need can use the support of Samaritans, which is free, confidential, anonymous, and is accessible any time of the day or night. Samaritan volunteers offer callers uncritical acceptance and respect in a comforting and understanding manner. In addition to supporting depressed, lonely and suicidal callers, this program also supports those calling with concerns for others. You can call them at 877-870-4673.

Samariteens is a teen help line that provides confidential peer support and understanding to teens who are struggling with feelings of depression, loneliness and stress. From 3 pm to 9 pm on weekdays, and 9 am to 9 pm on weekends, this service is staffed by volunteers between the ages of 15 and 18; outside those hours, calls are answered by adult volunteers. Teens call 800-252-8336.