Source: # Mental-Health Emergency and Safety *Tonight is a casualty problem first : Stay. Ask. Remove access if you can. Call. Do not keep a lethal secret.* ## 18.1 Why emergency knowledge is crucial Mental-health crises can be life-threatening. Knowing when a situation is an emergency and what to do can save lives. **Figure 18.1** *Match the response to the urgency.* Emergencies include: - Imminent risk of suicide or self-harm. - Risk of harm to others. - Severe psychosis or mania with dangerous behaviour. - Inability to care for basic needs (not eating, drinking, or sleeping for days; severe neglect). - Severe substance intoxication or withdrawal. In such situations, immediate action is more important than waiting for a perfect solution. ## 18.2 Recognising suicide risk Warning signs may include: - Talking about wanting to die, feeling like a burden, or having no reason to live. - Looking for ways to kill oneself. - Withdrawing from family and friends. - Giving away possessions or saying goodbye. - Extreme mood swings, agitation, or reckless behaviour. - Increased alcohol or drug use. - Recent severe loss, humiliation, or crisis (breakup, exam failure, financial ruin, legal trouble). Not everyone who shows these signs will attempt suicide, but they should always be taken seriously. ## 18.3 What to do if someone may be suicidal #### Do not leave them alone Stay with the person or ensure another trusted adult stays with them. Remove or secure potentially dangerous items if possible. #### Listen and validate 1. Speak calmly and respectfully. 2. Let them express feelings without interruption. 3. Avoid arguing, minimising, or moralising ("Think of your family", "This is selfish"). 4. Validate pain: I can see how much you are suffering. I am here with you. #### Ask directly about suicide It is a myth that asking about suicide puts the idea in their head. Asking can reduce isolation and open a path to help. You can ask: Are you thinking about killing yourself? Do you have a plan? Do you have access to the means? If they say yes, treat it as an emergency. #### Seek immediate professional help 1. Contact the person's psychiatrist, psychologist, or doctor if they have one. 2. If not, go to the nearest hospital emergency department or contact emergency services. 3. Know where the nearest hospital is. 4. Do not promise secrecy when life is at risk. It is better to breach confidentiality to save a life. #### Involve trusted family or friends Inform close family or friends who can help ensure safety. Share relevant information (risk, plan, means) so they can support monitoring and care. ## 18.4 When there is risk of harm to others Some mental states (severe mania, psychosis with threatening delusions, extreme anger with loss of control, substance-induced aggression) can increase risk of violence. Warning signs: threats to kill or seriously harm someone; possession of weapons with intent; severe agitation, paranoia, or command hallucinations; history of violence combined with current instability. Actions: prioritise safety of potential victims and the person themselves. Do not try to handle severe aggression alone. Contact emergency services or police if there is immediate danger. Inform mental-health professionals and family. This is not betrayal; it is protection. ## 18.5 Severe psychosis or mania Urgent psychiatric care is needed when there is complete loss of insight; severe delusions or hallucinations leading to dangerous behaviour; not eating, drinking, or sleeping for days; extreme agitation or aggression; wandering, getting lost, or inability to care for self. Do not argue about the content of delusions or hallucinations. Focus on safety and getting professional help. Contact the treating psychiatrist or go to the nearest hospital. Family may need to take initiative, ideally with medical guidance. ## 18.6 Substance-related emergencies Urgent care for: overdose (unconsciousness, slow or stopped breathing, blue lips); severe withdrawal (seizures, delirium, severe agitation); combining substances (for example alcohol with benzodiazepines or opioids); aggressive or psychotic behaviour under the influence. Call emergency services immediately. Do not give more substances or try home remedies. Keep the person on their side if unconscious (to prevent choking). Tell medical staff what was taken, if known. ## 18.7 Creating a safety plan A safety plan is written in advance with the person, family, and professionals. It may include: - Warning signs that a crisis may be developing (not sleeping, isolating, increased substance use). - Internal coping strategies (breathing, walking, calling a friend, prayer). - People to contact (family, friends, therapist, doctor). - Professional resources (clinic address, phone numbers, emergency department). - Steps to make the environment safer. - Reasons for living (family, goals, faith, responsibilities). Review and update the plan periodically. ## 18.8 After a crisis - Ensure follow-up with mental-health professionals. - Review what happened: triggers, warning signs, what helped, what did not. - Adjust treatment if needed. - Support the person and family emotionally; crises can be traumatic for everyone. - Reinforce hope: many people recover and live meaningful lives after severe crises. ## 18.9 Local resources Families should know: the nearest hospital with psychiatric services; contact details of local psychiatrists, psychologists, and counsellors; the local emergency number. Add a page with local resources specific to your area. ## 18.10 A simple story A STORY FROM ORDINARY LIFE — AMIT, AGE 25 For months, a heavy darkness had been swallowing Amit. He stopped going to work, locked himself in his room, and began telling his family that everyone would be much better off without him. His sister began to notice a terrifying shift. Amit was not just sad anymore; he started giving away his favourite belongings and making quiet comments about death. Recognizing these as severe warning signs, his sister did something incredibly brave and psychologically correct. She did not ignore it, and she did not try to offer empty platitudes like "everything will be fine." She sat down next to him and asked the hardest, most direct question possible: *"Are you thinking about killing yourself?"* Hearing the truth spoken out loud shattered Amit's wall of isolation. He broke down in tears and admitted that he had a plan. His sister followed the absolute rule of a mental health crisis: she did not leave him alone for a single second. She did not keep it a secret. She immediately called their parents, and together, they took Amit straight to the nearest hospital emergency department. Amit was admitted to the psychiatric ward where he was kept safe. He was started on emergency medication to stabilise his brain chemistry and began working with therapists. Healing took many months of hard work, slow adjustments, and unwavering family support, but the heavy darkness eventually lifted. Amit returned to his life and his job. **The Core Lesson** Looking back, Amit shared a chilling truth: that night, his exhausted brain had completely convinced him that his life was over. His sister's quick, fearless action was the only thing that bought him enough time for the medicine to work. In mental health, if you see the warning signs of suicide, you must never be afraid to ask the direct question. Asking someone if they are thinking about suicide does not put the idea in their head—it throws a lifeline to a person who is drowning in silence. A suicidal plan is not a secret you keep; it is a medical emergency that requires a hospital. ## 18.11 Reflection activity 1. Are you aware of local emergency numbers and mental-health resources? If not, how could you find them? 2. If someone close showed warning signs of suicide or severe crisis, what would be your first step? 3. What is one thing you could do this week to prepare (note the nearest hospital, discuss a safety plan, learn nearby hospitals)? 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