All American youngsters know the rules: Don't take candy from strangers, play nice in the sandbox and call 911 during an emergency.
But what if the emergency is related to mental health?
More than 4 million people visited the emergency room due to a mental health condition from 2009 to 2010, according to the latest data from the the Centers for Disease Control and Prevention. That same year, Americans made 63.3 million visits to doctors offices, hospitals and emergency rooms for what were eventually diagnosed as mental disorders, the CDC also found. "The reality is, a mental health crisis is a common occurrence," says Paolo del Vecchio, who directs the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services.
Here's what to know if one strikes you or someone you love:
1. Get to know a psychiatrist.
Mental health crises rarely arise out of nowhere. "Psychiatric illnesses, for the most part, evolve slowly, and so there's going to be a lot of warning," says Dr. Daniel Lieberman, the clinical director of the Department of Psychiatry at George Washington University Hospital. Ninety percent of people who die by suicide, for instance, give some indication they're considering it, he says. "There's this really irrational myth that people who talk about suicide do not commit suicide, and that's exactly the opposite of reality," he says.
That means that, in many cases, there's ample time to get in touch with a mental health professional before a mental illness -- be it a psychotic disorder, bipolar disorder or depression -- becomes an emergency. In addition to providing ongoing care that can help prevent a crisis, he or she can be your first point of contact should an emergency arise. "If somebody does have a relationship with an outpatient psychiatrist, that's the first place to go," Lieberman says.
Such a partnership is key after the crisis, too, since almost 1 in 10 people discharged from state psychiatric hospitals are readmitted within 30 days, according to SAMHSA. "Having that kind of ongoing care is critical," del Vecchio says.
2. Empower yourself.
Before a crisis, people with mental illness and their family members can benefit from educating themselves about a condition. Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation, recommends reviewing the American Psychiatric Association's consumer guide to the latest Diagnostic and Statistical Manual or reading other research-based materials on your loved one's condition. "Having a book is extremely useful because it really empowers the family and the person to understand the cutting edge information about these conditions," he says.
You can also be proactive by getting to know the lay of the mental health services land in your area, del Vecchio says. Your community may have mental health services outside of hospitals such as mobile crisis teams, respite programs, and triage and assessment facilities. One way to find out is through SAMHSA's treatment locator, which identifies mental health and addiction treatment settings based on ZIP code.
3. Recognize an emergency.
What constitutes a mental health emergency? Any time a person is an immediate danger to others or themselves, experts say. "In many ways, issues related to suicide are similar to having chest pain: This is an emergency, and it should be taken seriously," Borenstein says. In other words, if someone around you is threatening violence, call 911 or take the person to the nearest emergency room yourself, he says.
Other situations that warrant quick care include people who show signs of psychosis that affect their functioning such as delusions, paranoia or fear, Borenstein says. People who are extremely agitated, wild, overly active and unable to calm down should also raise red flags -- particularly if they don't respond to verbal interventions like saying, "Hey, can we sit down and talk?" Lieberman adds.
Sudden behavior changes should be taken seriously, too. "If something evolves rapidly, it's probably not psychiatric," Lieberman says. It's probably something really, really serious like poisoning, and they just need to be taken to the closest emergency room immediately." If you have a choice, head to an academic medical center, since clinicians there tend to be up-to-date on the most effective procedures and treatments, he says.
4. Know where (else) to go.
The emergency room is often not the best place to go in a psychiatric crisis since the waits can be long and the psychiatric care insufficient, del Vecchio says. What's more, most hospitals won't hospitalize patients for mental health conditions unless they are suicidal or homicidal, Lieberman says. "Mental health professionals are using hospitals less and less as time goes on," he explains, due to the high cost of care and low rate of reimbursement from insurance companies. That's part of the reason why it's often a better idea to call your mental health care provider (if you have one) or your primary care provider if you don't.
Not everyone has quick access to a hospital or psychiatric care, either. "There's a crisis in mental health care across the country," says Virginia Sen. Creigh Deeds, who has focused on mental health care reform since his son died by suicide in 2013. "As your skin darkens, as your income goes down, as the people around you are fewer and fewer, your access to care is tough, very tough."
If mental health care seems out of reach, try a hotline such as SAMHSA's suicide prevention line or disaster distress helpline, which can walk you through the safest steps, or use a resource like SAMHSA's locator, which can help you find the closest service.
5. Seek support.
Dealing with a mental health crisis is extremely stressful. In order to handle it as effectively as possible, the loved ones affected by a crisis need to take care of themselves, too, del Vechhio says. This might be by connecting with family members or friends who have gone through similar situations or reaching out to an organization like the National Alliance on Mental Illness, which has chapters in every state, he says.
"It's important to know that these types of things are fairly common and that they're not alone," Borenstein adds. "Treatment is available for their loved one."