So far this series has looked at identifying depression and anxiety, knowing where to get help and the types of help that are available. Mainly concentrating on depression or anxiety in relation to a life changing event and depression that you may struggle to identify a cause for. Most of the information has been in relation to the onset of the illness and relatively mild to moderate in severity.
Today I want to talk about mental health crisises. How to recognise that you are in crisis; and where you can access help.
How to recognise that you are in crisis:
A crisis can occur whether you have previously been diagnosed with depression or other mental illness such as bipolar, schitzophrenia or obsessive compulsive disorder. Or it may well come out of the blue and you were otherwise previously healthy as the first episode of a mental illness.
MIND the charity says that Mental health crises include:
suicidal behaviour or intention
panic attacks/extreme anxiety
psychotic episodes (loss of sense of reality, hallucinations, hearing voices)
other behaviour that seems out of control or irrational and that is likely to endanger yourself or others.
In a mental health crisis help is needed more urgently. However where as the majority of us know what to do in a physical emergency most of us wouldn't know where to get help if we or someone else is in serious mental distress. And the NHS infographics, such as the one below, don't cover mental health either.
Please note the above photo mentions NHS Direct which has since been replaced by 111. You can read more about this new service below.
I know I have mentioned helplines in most of the posts in this series but that's because they have a real role to play and are recommended by doctors and mental health charities. If the crisis is a part of an ongoing problem you may already be receiving care from a crisis team (which I will talk more about in my next post) and have numbers to ring for those directly responsible for your care. However if it falls out of those contact hours or you do not currently recieve crisis care the best helpline and one that is manned 24/7 is The Samaritans. Contact them on 08457 90 90 90
Your GP or Out of Hours
During the day you may be able to contact your GP surgery for an emergency appointment or phone call consultation. However this might not be guaranteed and you might have to wait longer than you feel you can. In which case the receptionist might be able to advise you where to go.
Outside of surgery hours you can contact your nearest out of hours service for an appointment.
I would say both above situations might be most beneficial in slightly less of a crisis, where you are worried but can wait longer. For example you might have self harmed and feeling a bit calmer but still want to report it and get extra help. As long as you can stop any bleeding. If however it is more severe or you have a more serious injury or burns then seek more immediate help, such as those listed below.
111 is the new service that replaced NHS Direct. It is to be used in more urgent circumstances where you cannot access your GP but where the situation is not presumed life threatening. In which case of course you would ring 999. They can also inform you of what action to take and where you can access the level of help that you need based on the information that you present them with. Whether it be for yourself or if you need to take action on behalf of someone else. From there they can make direct appointments for you or put you through to more specialist services such as A&E, out-of-hours doctors (and others depending on the case.) In some cases they can also send for an ambulance.
If you have seriously harmed (bleeding profusely or severe burns) yourself through self harm, injury or overdose or come across someone that is unconscious or unresponsive as a result of their actions then dial for an ambulance.
Go to A&E
Going back to those NHS info graphics they are designed to help stop unnecessary use of accident and emergency services because there are too many patients attending that could have been treated elsewhere, which in turn reduces waiting times and how quickly those in real need get treated. However like I mentioned they only cover physical health. Just like you would a physical emergency going to A&E if you are experiencing a mental health crisis is a real option and Accident and Emergency units do have policies and procedures in place for patients that present with the symptoms of a mental health crisis. In some cases if you have previously sought help from a doctor or NHS 111 they might even have told you to go to A&E. Go to A&E if you are also in need of physical treatment as a result of your mental state, such as deep self harm, injury or overdose.
There they will assess you and sometimes check for any infections that might be causing any symptoms (such as hallucinations) through a blood test and urine test. As well as treating any physical symptoms if you have any. If you're symptoms are beinv made worse by the waiting room environment (which are never easy to cope with anyway) ask if you can wait somewhere quieter. In some cases they will do this automatically. They will also keep a note of your clothing and physical description for security purposes. Should anyone in severe crisis leave the department. You should also be assessed by the psychiatrist on call, alongside a mental health nurse. Unfortunately crisis care at A&E can vary. Sometimes depending on how busy they are. I always used the same one but the experience differed on each ocassion. Ideally you should be treated as stated above. Put in a safe place and treated with compassion and understanding. You can be waiting a long time too to see a psychistrist depending on the time of day and how much other work they have with inpatients etc. But know that you are entitled to be assessed by a psychiatrist and that you have every right to be there. Even if you have no physical injury. Knowing your rights and where to get the help you need is really important
I remember during the times that I was in crisis and although the thoughts to do harm were overwhelming, on most occasions there was also a real fear. I was just so scared of these feelings. Personally, I saw that fear as a ray of hope, which might sound strange, but I kept telling myself that as long as that fear was there it meant that a part of me was fighting back; saying get yourself some help, get yourself 'somewhere' safe. However I also know that that fear also escalated those feelings of anxiety making my symptoms even worse. Panicking that I would totally lose control. But I am glad that through that I could say "I need help, now!" In hindsight I can see that the really scary times were those of total clarity and intention. The actual planning of 'I am going to harm myself.'
If you ever feel like that or come across someone that does then I hope this post has helped inform you of what you can do.
In my next post I'll talk about what care options are available for more severe cases.