When supporting someone with a mental health condition, part of the caring role may be to support them through a mental health crisis. In this video, Simon explains what we mean by a mental health crisis and ways carers can prepare if an emergency mental situation arises.
When supporting someone with a mental health condition, for some carers part of the caring role is to support the person they are caring for through mental health crises when they arise.
As a carer this can be a challening time, and so here we would like to take you through what a mental health crisis is, how to plan ahead, support someone through them and how to look afteryourself following a crisis.
What does a mental health crisis look like?
A mental health crisis is any situation where, due to a mental health condition, an individual behaves in a way that poses a risk of hurting themselves or others. This can also affect the individual being able to care for themselves or function in day-to-day life.
A mental health crisis will look different for every person. This is because it is dependent on the situation, the behaviours which pose the risk and how the individual responds.
- An individual making an attempt on their life.
- Self-harm or acts of self-injury.
- Self-neglect or an inability to look after themselves (not eating and drinking or taking care of personal hygiene).
- Activities which are against the law.
- Alcohol or substance use.
- Acts of violence.
- Risk taking behaviour.
- An episode related to their condition which detaches them from reality.
- A reaction to a trigger or stimulus.
- A change in medication or dose (for example, if the GP changes the prescription, or the individual does not take the prescribed dose).
- A life changing event or anniversary of an event.
- An increase in stress in day-to-day life like an increase in workload or financial pressures.
- Being physically unwell, like a flu or infection.
- A change to routine like loss of sleep or not eating.
How can carers prepare for a crisis?
As every mental health crisis is different, it can be difficult to know what to prepare for. That being said, there are a number of things that all carers can do to help prepare for the unexpected.
A care plan is a document which outlines everything you might need to know about someone and their care needs. This includes their diagnosed conditions, prescribed medications, the professionals involved in their care, symptoms and triggers, emergency contacts and any views or preferences which may influence the way their care is received. This document can be useful if you share the caring role with someone else, or you need to share background information about care needs with a health professional, such as a paramedic.
This is a plan of action for both the person with the mental health condition and their support network. It is designed to remove some of the decision making when in an emergency situation, offering a toolkit of information, resources, common triggers, and strategies to manage the risk of harm. It will also outline what has worked before which may help you and healthcare professionals manage the crisis faster and more effectively. To start writing a mental health crisis plan take a look at this template.
The Herbert protocol is a national scheme in which carers and family members can put together information about vulnerable people to assist police officers if the person goes missing. The form includes things like habits and routines, frequent places they visit, previous places they have been found, distinguishing features and a photo of the person. This can save time in the case of a mental health crisis where the person you care for has left the home. For more information on the Herbert Protocol see here.
Some carers have found it helpful to take a Mental Health First Aid course to develop their knowledge around dealing with mental health crises. There are a whole range of free courses online including this one from….
This is a document completed by the person with the mental health condition. It documents their preferred treatments and strategies in the case of a mental health crisis. It is not legally binding but it is a useful tool to ensure the needs and views of the individual are considered, even if they do not have capacity at the time. It can include what treatment they would prefer, who they would like to be contacted in a crisis, any religious views and any food preferences. An advance statement can also be created and agreed jointly with a healthcare professional. Find a template here.
Remember, you don’t have to deal with a crisis on your own. Whether it is a family member, friend or professional, there are people out there who can help. When building your support network, it can be helpful to think about who you could ask for support and what types of support might be most helpful in your situation. They don’t necessarily have to deal with the crisis directly in order to be part of this support network, just someone who can make it slightly easier for you (like someone who can pick up daily tasks or someone to talk to once the crisis is over).
Spotting the early signs of a mental health crisis
The first thing worth saying here is that warning signs are not always obvious and there are sometimes no warning signs at all. It is important to remember that you are not responsible for a mental health crisis – you can only help with the symptoms you are aware of and even with support, a crisis may still happen. Noticing the signs and symptoms can just help you to feel prepared for when a crisis arises.
Common signs and symptoms that someone is heading towards a mental health crisis:
- Not eating or drinking.
- Not undertaking personal care.
- Not taking their medication.
- A disrupted sleep pattern (too much or not enough).
- Extreme energy or lack of energy (hyper or hypomania).
- Rapid changes in mood.
- Confusion or irrational thinking.
- Losing touch with reality such as hearing voices or hallucinating.
One sign that an individual is heading towards a mental health crisis is that they stop following their usual routines or patterns of behaviour. Perhaps they’re not going to school or work, are not going out with friends or doing the things they usually enjoy doing. It might also be that they start breaking rules or boundaries or their relationships with others start to break down. These aren’t necessarily identifiable symptoms of their condition but is something that those close to them might notice.
By knowing their usual patterns of behaviour, carers will be tuned into any changes to routine which could be a trigger. For example, if their work closes over the Christmas holidays or a relationship ends which causes a disruption to their routine and makes it more difficult for them to cope, leading to a crisis.
Just because someone is displaying some of these signs or symptoms, it doesn’t mean that they will end up in crisis, they are just indicators that support or an intervention might be needed.
What to do in a mental health crisis
Hopefully the points above have given you some idea of how best to prepare for a crisis. But there is only so much preparing you can do and each crisis will be different. In the moment, you might want to try:
- Creating a space where the person in crisis is able to speak about how they are thinking and feeling. Open a conversation which allows them to feel listened to and understood but does not try to fix the situation. This is a useful tool to help to identify their needs.
- Removing them from the situation, especially if it is public. Find a quiet, comfortable space.
- Removing any triggers which are exacerbating the crisis.
- Creating distractions or finding something for them to focus their attention on.
- Physical touch and affection, like a hug when appropriate.
For some crisis situations, contacting the emergency services is the safest, most effective or only way to prevent the situation escalating. Calling the emergency services on a loved one is often not an easy decision but can be an important and necessary step in helping to keep them safe and getting the intervention they need to deescalate the crisis. In the event of your loved one being sectioned under the Mental Health Act, you can read more information here.
Here are a few practical tips from carers in our community:
- Have a go bag stored so they have the essentials if they are admitted.
- Bring the thing they wouldn’t usually stay anywhere without (like a blanket, teddy or favourite hoodie).
- Have a list of their medication history as well as all ongoing medication and treatments on one document.
How to understand and manage behaviour that challenges when supporting someone with a mental health condition
Behaviour that challenges is behaviour that poses risk to the person with the mental health condition or those around them such as self-harm, hitting or hurting others, shouting and swearing or destructive behaviours.
When dealing with behaviour that challenges, it is important to recognise that all behaviour is a form of communication. This means that there might be a reason for the behaviour such as an unmet need (like a need for their medication), their inability to cope with a particular situation or their inability to communicate their thoughts and feelings.
One way to prevent challenging situations is to identify and address any situations which have caused an episode of behaviour that challenges. By avoiding these or implementing measures early on when they do occur can prevent a situation from escalating.
When someone displays behaviour that challenges, the priority is to ensure that you, and the person you care for, stay safe from harm.
For some carers, this can be done by removing the trigger, taking them to a safe and quiet space or by accessing more support. Once safe, having the space to communicate their thoughts, feelings and emotions can help to de-escalate the situation.
Managing your wellbeing during and after mental health crisis
If you’re supporting someone going through a mental health crisis, the experience can really impact you, the carer, too. This is why it is so important to prioritise your wellbeing while supporting the person you care for.
After a mental health crisis, although the crisis is over, many carers find that their mind and body are still in crisis mode. Many carers need to take time for themselves to recover, recharge, focus on their own needs and process what has happened. As part of this, you might notice difficult emotions rising to the surface that you did not acknowledge during the crisis like frustration, sadness, worry, stress or overwhelm which needs to be processed. For more information and guidance on looking after your own mental health, refer to our guide.