If this is happening now: if someone has made an attempt, has taken pills or anything else to hurt themselves, has a weapon, or is in immediate physical danger, call 911, even if they seem fine right now. For an accidental poisoning or a medication mix-up, call 911 first if the person is unconscious, having a seizure, or struggling to breathe; otherwise call Poison Control at 1-800-222-1222, 24/7. For a mental health crisis without immediate danger, call or text 988. You can call 988 on someone else’s behalf.
At a glance
- Ask directly about suicide. Research has found no evidence that asking puts the idea in someone’s head, and some evidence that it may help.
- 911 is for immediate danger. 988 is for a mental health crisis, and it can connect callers to local crisis services where they exist.
- Stay with the person if it is safe to, keep things calm, and put distance between them and anything dangerous.
- The best time to plan for a crisis is before one. A short family crisis plan answers the questions you will not want to be answering at 3 a.m.
How do you know it is a crisis?
A mental health crisis is any situation in which someone’s behavior or state of mind puts them at risk of hurting themselves or someone else, or leaves them unable to take care of themselves. It does not always look dramatic. Sometimes it is a quiet, flat statement at the end of a long week.
Take these seriously, and act on them the same day:
- Talking about wanting to die, being a burden, or having no reason to live
- Looking for ways to hurt themselves, such as searching online or getting pills or a weapon
- Giving away belongings, saying goodbye, or putting affairs in order out of nowhere
- Sudden calm after a period of deep distress
- Drinking or using drugs much more than usual
- Hearing or seeing things others do not, or beliefs that seem disconnected from reality
- Not eating, sleeping, or taking care of basic needs for days
- Threats toward others, or agitation that keeps escalating
You do not need to be sure it is a crisis before you act. Deciding that is part of what crisis workers and emergency staff are there to do.
Should you ask about suicide?
Yes. Ask plainly: “Are you thinking about killing yourself?” or “Are you thinking about suicide?”
Many people worry that asking will plant the idea. Research does not support that worry. Reviews of studies on asking about suicide found no evidence that it increases suicidal thoughts, and some evidence that it may reduce them.
If the answer is yes, ask the next questions calmly: Do you have a plan? Do you have what you would need to do it? Have you done anything to hurt yourself already? The answers tell you how urgent this is and who to call.
911 or 988?
The two numbers do different jobs. 911 sends emergency responders to a life-threatening situation. 988 connects you with a crisis counselor who can talk with the person, talk with you, and help decide what happens next.
| Call 911 when | Call or text 988 when |
|---|---|
| Someone has made an attempt or taken something | Someone is talking about suicide but is not in immediate danger |
| There is a weapon involved, or someone is threatening others | You are not sure how serious it is and need help thinking it through |
| Someone is unconscious, unresponsive, or having a medical emergency | Someone is in deep distress, panic, or despair and needs to talk |
| You cannot keep yourself or others safe right now | You want to know what crisis services exist where you live |
In many areas, 988 counselors can connect callers to a mobile crisis team, mental health professionals who come to the person, or to a crisis stabilization program. What exists varies a great deal by state and county. Calls from phone carriers that use georouting go to a crisis center near the caller’s approximate location; other calls are routed by the phone number’s area code and prefix.
If you call 911 for a mental health emergency, say that clearly: “This is a mental health crisis.” Tell the dispatcher whether the person has a weapon, what they have taken if anything, and that you would like an officer trained in crisis intervention if one is available. Some communities send mental health professionals with or instead of police. Ask.
What to do while you wait for help
- Stay with them if it is safe for you to do so, or keep them on the phone.
- Remove what you safely can: pills, sharp objects, car keys, and anything else they could use to hurt themselves. Do not try to take a weapon from someone who is holding it. Leave and call 911.
- Keep your voice low and your words short. Fewer people in the room is usually better.
- Listen more than you talk. You do not need to argue them out of how they feel or fix the problem tonight.
- Do not promise to keep it secret. You can promise to stay with them and to help.
Things that sound kind but backfire: “You have so much to live for,” “Think about what this would do to your family,” and “Just calm down.” They tend to make the person feel unheard or guilty. “I’m really glad you told me,” “I’m staying right here,” and “We’ll figure out the next step together” usually land better.
Make a family crisis plan before you need one
If someone you love lives with a serious mental health condition, the most useful thing you can do may happen on an ordinary Tuesday. Sit down together, when things are calm, and write down:
- The early warning signs you both have seen before, and what the person wants you to do when you see them
- Their clinicians’ names and phone numbers, and the after-hours instructions for each
- Their current medications and doses, diagnoses, and any allergies
- Which hospital they prefer, and any past crisis experiences that went badly and why
- The local crisis numbers, including whether your area has a mobile crisis team
- Who will look after children, pets, or work if the person needs to go to the hospital
- Their own safety plan, if they have one, and your role in it
Keep copies where two or three people can find them fast. A person who has thought about their treatment wishes in advance may also want to put them in a psychiatric advance directive, which some states recognize as a legal document.
After the crisis
A crisis that ends without an emergency is not the end of the risk. Follow up the next day, and the day after that. Help the person get an appointment with a clinician that week, and go with them if they want. If they were hospitalized, the guide on the weeks after a psychiatric hospital stay covers what to line up.
The person who helped needs a plan too. Supporting someone through a crisis is exhausting and frightening, and it often goes on for longer than one night. NAMI Family-to-Family is a free class for family members of people with mental health conditions, and many communities have family support groups.
Sources
- 988 Suicide & Crisis Lifeline — 988lifeline.org: call, text, or chat, 24/7; calling on behalf of someone else.
- Substance Abuse and Mental Health Services Administration — 988 Suicide & Crisis Lifeline: what 988 offers and how it connects to local crisis services.
- Substance Abuse and Mental Health Services Administration — 988 Frequently Asked Questions: how 988 calls are routed.
- Substance Abuse and Mental Health Services Administration — National Behavioral Health Crisis Care: crisis lines, mobile crisis teams, and crisis stabilization.
- Dazzi T, Gribble R, Wessely S, Fear NT — Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 2014.
- Blades CA, Stritzke WGK, Page AC, Brown JD — The benefits and risks of asking research participants about suicide: a meta-analysis of the impact of exposure to suicide-related content. Clinical Psychology Review, 2018.
- National Institute of Mental Health — Warning Signs of Suicide.
- American Foundation for Suicide Prevention — Risk factors, protective factors, and warning signs.
- National Alliance on Mental Illness — Navigating a Mental Health Crisis: what to tell 911, crisis intervention teams, and preparing a crisis plan.
- National Alliance on Mental Illness — NAMI Family-to-Family.
- America’s Poison Centers — Poison Help: 1-800-222-1222, and when to call 911 instead.
- Harvard T.H. Chan School of Public Health — Means Matter: Families: reducing access to lethal means at home.
- Crisis Text Line — crisistextline.org.