Emergencies

Plan for a crisis by learning when to call 911 versus 988 and what to know about state laws and
local protocols if a loved one who needs treatment might be unwilling to go.

Note: Treatment Advocacy Center is not a crisis intervention service and cannot provide emergency help. 

What should I do in a mental health emergency?  

If a mental health crisis includes a risk of harm to self, others, or property, emergency personnel need to be contacted. Act now: 

• Call 988 if emergency intervention is needed but there are no weapons, violent elements, or serious injuries.
• Call 911 if the situation is dangerous and law enforcement or urgent medical care is needed.

Will 911 work if I live somewhere different from the person in crisis?

Maybe. Call and request a transfer. A dispatcher will work faster if you have an exact location for the person in crisis—a street address with city, state, and zip code—along with their telephone number.

If there’s time to plan for an emergency that could happen elsewhere, check the website for the police department. Look for a 10-digit emergency number, sometimes called the public safety answering point (PSAP). If you cannot find this number, call the non-emergency number for the police department, and say: “I need the 10-digit number to call in case of an emergency or for a transfer to dispatch.” 

Save the 10-digit number with your emergency checklist (see below).

More about 988 

988 is a nationwide Suicide & Crisis Lifeline, with trained crisis counselors who address mental health situations and offer resources. If indicated and locally available, a 988 responder may be able to initiate response from a mobile crisis team. You must share the location of the crisis for an in-person response; 988 calls are routed based on area code, without geolocation.

Call, text, or chat 988 to connect with a trained crisis counselor. Interactions are confidential, free, and available 24 hours, 7 days a week, 365 days a year. Services are immediately available in English and Spanish, with interpretation upon request for more than 250 languages. Those who are deaf, hard of hearing, and TTY users can use preferred relay service or dial 711 then 1-800-273-8255.

Contact 988 if you or someone else is having: 

• Thoughts of suicide.
• Mental health crisis.
• Substance use crisis.
• Emotional distress.

Veterans can press 1 to be directed to a specialist in veterans mental healthcare. The 988 website includes resources specifically for veterans. 

For suicide and mental health emergencies for individuals who identify as LGBTQ, another option is to contact the Trevor Project, 24/7: 1-866-488-7386, text START to 678-678, or chat TheTrevorProject.org/Get-Help.

More about 911 

Call 911 for a violent situation or if there is a serious injury. When the 911 dispatcher answers, you might start with this: “My loved one is having a medical emergency because of a psychiatric illness. We need you to send CIT-trained officers.”

Use simple, clear language to explain SMI symptoms and the nature of the situation. Let the dispatcher know if you or anyone else is in danger and if the person in crisis has access to weapons. A local dispatch center will route your emergency to police and/or paramedics.

What is CIT? 

Crisis intervention teams training (CIT) is most known for training law enforcement officers on mental health basics and de-escalation techniques but is intended to be more than that. CIT strives to create a community partnership of law enforcement, mental health and substance use professionals, individuals and families with lived SMI experience, and other partners to improve community responses to mental health emergencies. 

According to CIT International, “The CIT model reduces both stigma and the need for further involvement with the criminal justice system. CIT provides a forum for effective problem solving regarding the interaction between the criminal justice and mental health care system and creates the context for sustainable change.” 

What is a mobile crisis response? 

If available, a mobile crisis response service might provide an in-person team to try to stabilize the situation and set up next steps. Mobile teams may not respond immediately, so be prepared to call 911 if a situation escalates while you wait.

Mobile teams have many different names. Some include a partnership between mental health clinicians and law enforcement for a “co-responder” approach. Community responder programs generally don’t include law enforcement but utilize various professionals and peers, who provide emotional support informed by lived experiences.

Here are ways to research what’s locally available:

• The Right Response provides a directory of crisis response organizations that offer an alternative to law enforcement.
• Search online by typing county, state, and “mobile crisis response.”
• Ask a local provider or a 988 counselor about mobile response options in the area.

Pro tip: If a mobile crisis response team leaves without access to your loved one, plan to call again—and again—and again. You are creating a record of the crisis, and not all responders will approach the situation the same way.

Can an emergency be used to initiate mental health care?

If the person in crisis lacks awareness that they have SMI due to the symptom of anosognosia they may insist there is nothing wrong, despite symptoms and concerning behaviors that are obvious to others. In those situations, an emergency might lead to a frustrating stand-off between the person who is ill and those attempting to help. It also might be the first, best chance to shift a person toward mental health care that can lead them to recovery. Planning an approach for care increases the chances for a helpful outcome, and the first thing to learn is state law.

What should I learn about state law?

Every state has its own laws describing the criteria that must be met to transport someone to an inpatient mental health facility against their objection. Those criteria describe how long a person can be initially detained for evaluation and treatment, and the court process for civil commitment, or court ordered hospitalization, if continued inpatient treatment is deemed necessary. Look up your state on TAC’s interactive map to read the treatment laws that relate to emergency evaluation, inpatient and outpatient commitment.

Criteria for emergency evaluation are often, but not always, the same as the criteria for inpatient commitment and generally require a person to pose a danger to self or others as defined by the legislature. Danger to self always includes the risk of suicide or direct self-harm but can include other kinds of harm, such as grave disability.

Grave disability describes a person who is unable, due to mental illness, to provide for basic needs such as food, clothing, and shelter. In many states, grave disability includes being unable to appreciate the need for lifesaving medical care or to protect oneself from harm (such as walking into traffic). An increasing number of states include a risk for worsening psychiatric deterioration as part of the standard.  

Pro tip: When advocating for a person in crisis to receive an emergency evaluation, consider describing symptoms and behaviors using state language. For example, a Washington State family member might explain a loved one’s “loss of volitional control” while describing a current behavior of violently destroying their home’s walls and smoke detectors because of a deeply held belief that the house is under CIA surveillance, demonstrating “danger to self” and “danger to property” due to “grave disability,” using phrases from statute.

What might happen next, after transport for an emergency hold?

A person on an involuntary hold is taken to an inpatient facility. If there is no appropriate psychiatric bed available, they might stay in the emergency department or crisis facility. This is referred to as “emergency department boarding,” and has been an increasing problem as the number of psychiatric treatment beds continues to shrink.

Though theoretically an unstable person should not be discharged, many pressures incentivize hospitals to discharge patients as quickly as possible. Some hospitals deny care if a patient is “too acute” for their staffing model, even if there is an available bed. Other barriers may be related to insurance.

Pro tip: Try to avoid premature discharge by promptly sharing mental health history, preferably by fax, with the facility. Share this information with each transfer; don’t expect these documents to travel with the person. If a premature discharge happens anyway, consider options for filing a complaint or for advocacy. Keep in mind that responding to constituent concerns is part of the job for elected officials and consider contacting a county or state official if that level of advocacy feels doable.

Is commitment a possible next step?

If the person is kept in the hospital and evaluated, the treating provider may determine that they meet criteria for continuing hospitalization—often called commitment. A provider’s petition to extend a hold triggers a judicial review. During that process, the patient has the right to be represented by an advocate or attorney.

Family members may be permitted to submit written or oral testimony for the civil court process in which a judge decides whether to order a commitment. The family can share information about the person’s condition, medical history, and/or recent behaviors.

In some locations, a judge may also rule on whether medication can be administered against objection. If medication against objection requires a court order that is separate from a commitment order, the family may need to advocate for hospitalization and treatment.

How long a person is held can be a fluid process. State commitment laws often allow a facility to hold a person for “up to” a certain time. Another civil court process is required to extend the stay. Hospital staff may quickly discharge a patient any time a new assessment determines that the person is no longer at risk for harming themselves or someone else.

How do I build an emergency plan? 

People often go blank during an emergency, so prepare an easy-to-find-and-follow checklist ahead of time. Having a plan in place can help ensure that the emergency is handled as a medical need for treatment—ideally avoiding criminal legal system involvement. Periodically check the information in your emergency plan to ensure it stays up to date.

Items for an emergency plan:

• Clearly labeled, with hours of operation, all numbers you might call in an emergency: 988, 911, local crisis hotline, local mobile crisis response service, long-distance 10-digit PSAP number (see above).
• Full address information for any location where a crisis might unfold.
• List of current or recent providers, with name, address, phone number: If a service agency has its own emergency response program, include that phone number and hours of operation.
• Psychiatric advance directive (PAD), if available: During times of stability, a person with SMI might write a PAD to share their wishes if they lose capacity.
• Quick facts about your state’s treatment laws, with key words about what is required for responders to issue an emergency hold and transport someone to a receiving facility. Prepare to use language from the criteria (such as grave disability, imminently threatening harm, etc.), while truthfully explaining symptoms and behaviors that led to the emergency.
• A list of who can petition for an emergency hold. This information is included in the state statute for emergency evaluation. In some states, a concerned community member can petition the court directly and in other states only certain professionals are authorized to petition. Print and store relevant documents about the petition process. If a credentialed professional is required, make sure that person is part of a crisis response team when you call.
• Mental health history: TAC provides an article with a fillable form to help you keep a timeline of events, details about symptoms, and a medication record. Prepare to discuss how documented behaviors in the past have led to similar risks for harm. Share this form with first responders and with each and every facility providing evaluation and treatment.
• Photos and/or information about videos you have, with dates and location information, to use as evidence of symptoms, illness-related behaviors or threats, or a person at baseline to demonstrate a contrast. Share photos, videos, and other physical evidence in real time if possible, during an in-person response.
• Facilities in the area, with addresses, phone and fax numbers, that might receive someone put on an emergency hold: general hospital emergency department, psychiatric emergency room, crisis diversion facility, or somewhere else. Consider requesting transport to a facility of choice, if possible.
• Names, addresses, phone numbers for outpatient services that might be a good fit for discharge planning. Learning about options along the continuum of care can help with research to build this list. For example, is there an assisted outpatient treatment (AOT) program that might provide care under court order upon discharge? If yes, the time to start talking about AOT is upon admission.

A note on resources 

In several places above we have detailed what is ideally available to address a crisis or emergency and next steps. As with almost all aspects of treatment and care for mental illness or substance use, what is available varies widely by location. There may or may not be a CIT trained unit where you live. You may find that even in locations where mobile crisis response exists there are not enough teams to serve the area in a timely fashion. 988 is a new system that is improving and growing quickly, but it will inevitably face bumps in the road in the same way 911 did when it was launched.  

This reality provides an even greater incentive to do research on what is available where you live and plan. In an ideal world, all individuals and families affected by SMI would always have the full array of crisis services available. Until then, preparation and planning can help.