How to help someone in a mental health crisis
Mental health crises can happen abruptly or build over time, and experts say early recognition and early conversation can help someone get connected to support. In the United States, experts point to ongoing public-health concerns about mental health and suicide, while also emphasizing that a crisis can look different from person to person.
Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association, said a crisis may not look the same for everyone, but the pattern can still be recognized. “My crisis might not be your crisis, but what we do know is that — however people define crisis — there is a change in how they’re feeling, a change in how they’re behaving,” Rivera said.
Experts told The Associated Press that some warning signs may start subtly before they become more obvious. They said people may stop enjoying things they used to like, pull back socially, show sleep irregularities or decreased hygiene, or increase their use of alcohol or drugs. Other signals include extreme mood swings and changes in speech or outlook, including talking about being a burden on others, feeling hopeless, or expressing thoughts about wanting to die or kill themselves.
If someone’s behavior shifts in ways like those, crisis intervention experts say the next step is to talk rather than wait. The guidance they offered focused on treating the person’s experience as real even when the cause is unclear, and on approaching the moment as an invitation into support rather than a confrontation.
Before starting, experts recommended pausing to prepare. They said it can help to research tips and resources ahead of time on organizations’ websites, including the National Alliance on Mental Illness, The Trevor Project, the American Psychological Association and 988. They also urged people to reach out to 988 directly—by calling, texting or chatting for guidance on how to begin the conversation.
For the conversation itself, Alex Boyd, director of crisis intervention at The Trevor Project, which runs a suicide prevention hotline for LGBTQ+ youth, laid out a four-part approach. He said the conversation should begin with an open-ended question that acknowledges the shift in behavior—such as telling the person, “I noticed you haven’t been showing up to (the space we share) recently. I want to check in. What’s going on?” Boyd also said a helper should express care and concern, ask what the crisis looks like for the person, and then acknowledge the moment is tough before asking directly about suicide or self-harm.
Boyd said it is important to be straightforward at this point and to treat the helper’s role as supportive rather than clinical. He advised asking: What’s been going on for you that has led you to (name the change in behavior)? What’s changed for you? What are you concerned about? And after acknowledging it is a difficult time, the helper should ask directly, “Are you having thoughts of suicide or self-harm?” Boyd also said at that stage the helper should consider other supports and resources, asking: “What would feel helpful right now?”
The experts also addressed a common concern that asking about suicide might “put the thought in their mind.” They said that myth is not accurate and that it is very important to ask directly whether someone has plans to harm or kill themselves and whether they intend to act. Boyd said if someone has a plan, he recommends saying something like: “What would lead you to actually take that step? Because that sounds scary. I don’t want that to happen. What would lead you to feel more escalated to act on the plan?”
In cases where someone is in immediate danger of harming themselves or others, experts urged people to seek professional help right away. They said 988 or other helplines can connect someone to crisis intervention teams and specialized resources, and they noted that calling 911 or going to an emergency room are also options—while adding that not all emergency medical service personnel or dispatchers are trained in mental health intervention.
Experts cautioned that starting the conversation is only the beginning and that barriers such as stigma can slow progress or shut people down initially. Tia Dole, who oversees the 988 lifeline, said some people may not respond the first time someone tries to talk, but may come back days or weeks later. She also said some people may shut down if helpers jump quickly to diagnostic words like “depression” and “anxiety,” and she recommended using “parallel activities” to reduce pressure—such as taking a walk or talking during a car ride—so someone can open up without the formality of a typical conversation.
Dole also emphasized validation without minimizing. She advised people not to dismiss what the person is experiencing as “just a phase,” and she said that while sharing one’s own experience can sometimes be helpful, the conversation should not become centered on the helper. Over the long term, she said getting help through traditional clinical care can be hard and can take perseverance, noting that people may have to try several therapists before they find the right fit.
Dole also encouraged support from nonmedical resources, including faith-based organizations, community centers and schools. And she said people should not let news that a loved one is struggling change how they view that person. “Being suicidal or having a mental health crisis does not diminish who they are as your loved one,” Dole said. “They’re still them.”
If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988.