Ep. 186-Navigating Mental Health Crises: A Guide to Overdose, Self-Harm & Suicide Risk
This episode gives a step by step guide to managing mental health crises like self-harm, suicide, drug withdrawal or overdose threats.
Most people feel completely helpless when someone they love descends into a mental health crisis but what if you had a clear, plan that could save lives? In this episode, Dr. Kibby shares the insider knowledge she gained from working in psychiatric emergency rooms and supporting families through the most dangerous moments. Whether it's a loved one overdosing, becoming violent, or threatening suicide, knowing exactly what to do can make all the difference and even prevent tragedy.
Dr.Kibby demystifies the chaos of mental health emergencies. She walks you through what really happens inside the hospital, explains how to recognize dangerous signs like alcohol withdrawal or impulsive self-harm, and reveals the untold reality of involuntary holds and crisis interventions. She shares personal stories and offers practical, repeatable steps to de-escalate crises before they escalate further.
Tune in for actionable tactics: how to create a tailored safety plan, the best emergency resources like 988 and mobile crisis teams, and when to call 911 versus seek professional help. You’ll learn concrete warning signs and calming techniques from DBT skills, as well as how to assemble your support network in advance. Safety planning isn’t just for professionals- it’s your first line of defense. With clear advice rooted in real-world experience, this episode equips you to act decisively when it matters most. Don’t wait for a crisis to strike! Prepare now, protect those you love, and reclaim your peace of mind.
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Dr. Kibby McMahon (00:03)
Welcome back, little helpers. Today we're going to talk about safety planning. What to do if someone you love is going through a mental health crisis. And I don't just mean is really, really stressed, but I mean if someone gets so dysregulated and out of control of their emotions that they tend to do something dangerous, like hurt themselves, hurt you, ⁓ take drugs or drink and drive, throw things, threaten.
someone's safety in some way, just anything that it seems like they might be at a danger to themselves or someone else. So I'm gonna talk about that, about what to do when it comes to seeing someone go a little bit over the edge in ways that are really scary. ⁓ I've been thinking a lot about this because this is what we're talking about in KulaMind , which is my program for...
supporting loved ones of people with mental illness, especially people who are dysregulated and have borderline personality disorder or addiction, maybe all those things. We're talking in the group about how to actually handle something like that. We're really going through the steps of what to do. I feel like if you're not really familiar with this world, it's like this black box of, guess I'll call 911 or-
I'll take them to the hospital, right? I'll take them to D-Tile, I'll take them somewhere, right? But ⁓ sometimes it's really helpful to know like what does that, what's inside that black box? Like what does, what actually happens when someone's mental health reaches a level of severity or risks that they have to be taken somewhere? Even getting them help when they don't think they need help or...
maybe sometimes against their will. So it's all a really scary thing, but I think that it's important to really talk about it and plan for it in advance because the studies really show that if people, especially loved ones, families and friends around someone with mental health struggles, if they do some safety planning in advance before a crisis happens, then it just goes much better. They're able to...
get the right help, they're able to sometimes save lives, ⁓ take their loved one to the hospital when it was really medically necessary. there is, it's so scary because all of these mental health emergencies are just happening at home, at work, you know, ⁓ with your loved ones. And it's like all of us people around, you know, people who are struggling are just like.
We are the first responders. We're the ones who is like, my gosh, what do I have to do now to keep this person safe or me safe? ⁓ And there's no training out there. So I really want to get out more information about what it looks like. What do people do? Which should families and loved ones do? And what does it look like when you actually take your loved one to emergency services? I'm also gonna talk a lot about, I'm gonna talk about my, hold on, cut that part out.
And I'm mostly, I'm gonna talk about some of my experiences personally, being a loved one, bringing my mom to the hospital, but also I was a DBT therapist, dialectical behavioral therapy therapist, was working with people who were like in and out of the hospital in the emergency room and who had a lot of crisis on their own. But also I got a really amazing experience working in a psychiatric
emergency room doing my internship. I actually was doing this podcast while I was working there. I bet, you know, if I look back, there's probably a lot of cool stories, but it really let me see what does the system look like. And it really demystified it for me. So I'm going to try to give you that insight too. what I'll just, you know, hold on, let me think about where.
Okay, so I'll just talk about what it looks like when someone is taken to the emergency room. And then after I'll at the end, I'll talk about how to make your own safety plan for you or someone else. the emergency room. ⁓
So.
What I'm
So let's say you have a child partner, sibling, friend who has really intense mental health issues. And it could be all sorts of things. I think I hear the most alarm when it comes to ⁓ having people in your life who's dysregulated, meaning that they lash out and they tend to cut themselves or...
the scariest thing is when they impulsively hurt themselves. Like they didn't mean to, they weren't planning on it, but then they got really upset and they cut themselves or they tried to take their own life, right? So those are the scariest, from clinical standpoint, that's the scariest because it's, as you imagine, unpredictable and impulsive. So that is the one type of...
crisis that we're talking about, but this also could be drug related, right? Like if someone has an overdose or one really big emergency that people should know about is if someone has a withdrawal from alcohol and benzodiazepines, like benzos, like Xanax and stuff like that. So I don't know about benzos, but I know that alcohol withdrawal is, it could be deadly.
So it's really dangerous. So when people see it, they shouldn't just go, eh, you know, like they'll, they'll, you know, muscle through it. They need to go to the hospital. And I, my first exposure with that, the first I learned trial by fire was when, when I was in high school and my mom who at the time was drinking quite a bit daily. She decided to go cold, cold Turkey. Cause family were visiting and she was just like, okay, I'm going to stop.
drinking and I was actually out of the house at this time ⁓ but I got a call that my mom was in the hospital because she had had a seizure and that was the first time that I heard about how dangerous it actually is to withdraw from alcohol. I'd like begged her and to stop and if someone's drinking a lot you just sort of like just stop just like just go just get sober and a lot of people do have these
good intentions where they're like, I want to stop, I'm going to stop. if they do suddenly after really heavy drinking, what alcohol and benzos do is they depress the nervous system, right? So they actually make your heart rate slower, like everything kind of calmed down. So they like make you calm, right? They like bring down this ⁓ sympathetic nervous system. ⁓
But then when the nervous system adjusts to that and is used to having that depressor, then if you suddenly stop, right, like your nervous system goes nuts, heart races, and it actually can lead to a heart attack or other kinds of issues. So ⁓ what that looks like, like serious withdrawal symptoms from alcohol benzos, it's shaky tremors. ⁓
agitation, like needing to move around a lot, like maybe intense anger or ⁓ all signs of like someone's like raring up, right? Like fight flight. ⁓ They might feel really anxious or nervous. And then the really serious symptoms are like when you're shaking tremors, when there's delirium, like they get confused or even like say things and see things that don't make any sense.
⁓ And if they're heart racing a lot, maybe they're also sweating too. So if you have a heavy drinker your life and suddenly they stop cold turkey ⁓ and you see any of these signs, you've got to take them to the hospital. You got to take them to the ER. We always recommend when you're detoxing from anything to do it safely, either, especially if you're alcohol addiction, going to a detox center.
So you could be medically monitored and actually have that whole, you know, getting used to not having such like breaks on your nervous system, like slowly, slowly come off, right? So ⁓ if you see someone getting sober and then they have all those symptoms and they kind of, they seem agitated, sweaty, shaky, tremors, ⁓ irritable, pacing confused, take them to the ER. I remember
Sadly, this is one time when my childhood came into very good use at this point, when seeing that happened to my mom. ⁓ And then I was working in the ER and I remember someone coming in and I'm going to try to keep their information really confidential, as I will with all these stories, but they were really agitated. They were really...
They were like, I don't know, I'm just kind of like really anxious and freaking out. I can't sleep. it seemed like coherent. it was unclear to us what was happening. So when you get to the ER, the whole point of the emergency room is a triage. It's almost kind of like a triage center. It's where people go to have like,
a whole medical staff and psychiatrist evaluate you and see if you're at risk. ⁓ And what kind of risk and what do you need to do to stabilize and keep that person safe and then direct them to the most appropriate care. That's what the ER is for. It's like kind of like a holding station to be like, okay, let's keep you safe. ⁓ Give you meds that you need, ⁓ you detox, help you.
and not hurt yourself and then after that stabilization period, do you need to go to inpatient? Do you need to go to intensive outpatient? Do you need to go home with a recommendation for a psychiatrist, a psychologist? So ⁓ it's kind of like a place where they hold you and they figure out what's the best move after that. So this person came into the ER and was just really like.
Agitated like really couldn't sit still and was like, I don't know. I don't feel good I don't know what's going on and after talking to their loved one their partner what I Actually talking to them now is coming. It's coming back to me. The person was like, yeah, I was I'm generally trying to be healthy I don't know what's happening. Like I I didn't I stopped having a couple of drinks I usually have a couple drinks at night, but I didn't this time and I've been working out and
Maybe it's something with my medications, I'm not sure, but I just feel really anxious and I don't feel good. And I was talking to their loved one, their partner, and their partner was like, oh, let me tell you how much they usually drink. writing it down, it was like, it wasn't just a couple drinks, which a lot of people say, like, oh, I'll just have a couple drinks, but it was like three glasses of whiskey a night or something like that. And...
I was like, oh, I didn't know it was that much. And then when I was talking to the psychiatrist and immediately we all were like, oh my God, this person is going into alcohol withdrawal. This is very serious. And even when they were waiting in the hospital bed, they were pacing around. They were like unable to sit still. I gave them a little breathing skill, but it wasn't really working. They were just like walking around, walking around unable to just sit quietly.
And so the psychiatrists were like, my God, okay, emergency. And they were given some medications to make sure that ⁓ they didn't go into cardiac arrest. So that was like a moment where I was like, you know, my childhood had its dark moments, but I'm happy that I learned ⁓ that. Because you think that, you don't expose all this stuff. You think that...
this is all like dramatic stuff, right? If someone is addicted to like heroin, like that's like a dangerous overdose or withdrawal and it is, but alcohol is a surprisingly dangerous withdrawal. So if you're hearing this, please take your loved one to the ER right away. ⁓ But then also it's, then you have the drugs and alcohol whole thing, but then you have...
Like what if someone is getting violent? What if someone is about to hurt themselves? I always say better safe than sorry. Like if you're not sure, even if someone is joking or not joking, but if they say, I'm gonna kill myself and you're scared. I think the thing that loved ones tend to do that's so horrible for everyone involved.
is that they're terrified and they kind of have a freeze response, right? I'm hearing a lot of people, and KulaMind especially, like, they go, yeah, I might get a text from my loved one and they say, like, ah, I'm just so upset, I'm just gonna kill myself, and then I'm anxious for the rest of the night. Like, yeah, well, then that's where a safety plan should come in, right? If someone is saying they're gonna hurt themselves or threatening to do so, and especially if they have a history of that, even if it's long ago, then...
We should take it seriously. In those moments, if someone is joking, like sometimes people do, of course, it's like in our common language to be like, I had such a terrible day. I want to die, right? ⁓ Which is awful that we have that as part of our common language. And it really confused. It's like it's like ⁓ boy who cried wolf kind of thing. It's like, you don't know when is like a joke and when it's just an expression of I'm.
really, really in pain or really upset or really sad and when it actually means like I'm at risk. So we would, we always try to tell, get this out. We always try to tell people this. It saves lives when you ask directly whether someone is suicidal or has urges to hurt themselves. ⁓ People think that if I ask,
my loved one or family member, ⁓ are you thinking of her or yourself? That gives them the idea. And that's not really the case. It doesn't work that way. It's not someone who's sitting there and going, wow, well, now that you mention it, that sounds like a great idea. What happens is that people are going to be often honest with those thoughts and feelings. And ⁓
It can really make a huge difference of saving someone's life if you talk about it directly. you can ask if someone is even saying something like that, I'm going to kill myself. can say, wait, hold on a second. That really freaks me. That really scares me. I'm really worried. Tell me more about that. When you say I want to die, you mean that you have thoughts of death or hurting yourself? Do you have plans to do it? Do you think about how or when you would?
Right? So the more concrete of a plan it is in their minds, the more risk there is, right? If someone goes, no, just kidding. I think the appropriate thing to say is, well, don't joke about that because I'm really scared, you know, given your history, given your mental health struggles, you know, I just want to make sure you're safe. So please don't tell me that. But if you actually are having thoughts of death, like or hurting yourself, please let me know because this is serious. I don't want to keep you safe. If they say something like
Yeah, I think about it. I think about how I would do it this way. And I know it's so easy because we have this in the closet, right? And especially if they're like, yes, I'm going to do it on Saturday. That is intent and plan. That is a really high risk. And that's when you go, all right, let's figure out how to keep you safe.
Let pause for second.
So first I'll kind of go through what the world of taking someone to the ER actually looks like. It's really useful, but there's parts of it that are very frustrating. as a daughter of someone who was in and out of the hospital growing up, I really was bummed out that we didn't have a better system.
I know that a lot of friends and people I know who have really severely ill loved ones are very frustrated because you might as a loved one know best about what someone needs, right? If someone is in an episode, they are really intoxicated or they're really upset and they're going to hurt themselves in some way, you as the bystander might know.
my God, this person really needs help, but that person might not feel like they need help, right? And so there's so many situations where people go like, how can I just get this person into treatment? How do I get them into therapy? Like I'm actually scared for them to be wandering around. And I think they need to be in an inpatient hospital somewhere. They need to be somewhere safe and get real treatment. But there's not a lot of great ways to force people into therapy, right?
We can do an involuntary hold in the ER if that person is at risk of harming themselves or someone else. Like if they're a danger to themselves. It's actually kind of different between someone who is suicidal versus ⁓ on drugs or drinking. If they're sober and they're able to say, like, understand that I might be at risk by taking this and they're in their right mind, like, they're not necessarily considered dangerous to themselves.
But if they are suicidal, like I'm afraid of hurting myself, that's when they would get kept in the ER. So this is more venting and more like, I just remember really sad times when, ⁓ like there's one time when I was just like, it was like fighting my mom to get her into the hospital. She kept insisting that she is not the one with the problem. Everyone else is the problem. But a couple of times,
it got hairy enough where I could, you we got her into the ER because of other health issues. And I just, like one of the worst days of my life, I'm not going many, but one of the worst days of my life was getting her into the hospital. And then she started to detox for a couple of days. And the detox from alcohol, as I mentioned, is pretty terrible. It's really uncomfortable. It's scary. And the person just wants to drink.
And also it's not really fun to be in hospital, right? Like ideally, you know, I wish that we had a system where if someone was in a mental health crisis, they could be whisked away to like a beautiful spa where there's all sorts of specialists on hand and it's like a healing, you know, lovely medically monitor place. But instead we have the emergency room, which is like the beds are uncomfortable. There's long waits and there's security guards could be scary. And, know, some there's like it looks
sometimes looks like a jail, you know, it's it's scary in some ways. So my mom was not having it and I remember like on the second or third day of her detox, which is one of the most dangerous times, she wants to wanted to go home. She's like, I had enough of this. I'm going home. It was like high school. So was probably in like my junior, senior year, about my junior year. And the doctor turned to me and they were like,
It is not advisable for her to go home right now. This is one of the most dangerous times of the detox and she could die. She could die overnight and I think if she leaves now, she's going to die. I was terrified. you imagine? My mom was like pulling out her IVs and getting dressed and saying, I'm leaving. And the doctors were like, she's gonna die if she leaves.
And I was like, well, then tell her that. So they did their protocol. They sat down with her and they said, and they brought in the psychiatrist and they said, do you understand that if you leave now, you have a high risk of dying? And she was like, yep, I'm out of here. So hearing my mom basically be like, I know I'm gonna die and too bad everyone. I was like, I remember.
I remember what the psychiatrist looked like. was a little Asian woman. And I remember the conversation. And I remember my heart sank. I remember being like, why don't you guys say more? Like, convince her to stay, please. Like, just say anything. I mean, they were just like kind of saying what they needed to at a protocol. But I was like, I can't be the only one fighting for this. I'm fighting against her, against her wishes to keep her alive. Please help me. I'm a kid. I was like,
15, 16 at that time. So she was like, no, I'm out of here. And then she leaves. the thing is that I'm begging her to, I'm trying to negotiate with her to stay in there because the moment that we discharged from the hospital, then we lost the bed, we lost the spot. It's not like you could walk in and be like, oh, bye, and then come back and be like, actually, I saw the arrow my way.
You have to go through the ER system and have to be assigned to a bed, right? It's like a whole, it's a whole process. So I was begging her to, and I remember there's this really sad moment and I feel cringy even just like remembering this, but she started to run down the hall of this fancy, beautiful hospital. It's like balcony. I remember this long hallway. was like a balcony over at Atrium and she's running and I'm running after her.
and I'm trying to grab her and I literally like grab my mother and I like I think I grabbed her right as she was getting into an elevator and dragging my fully grown mother and she's kicking and screaming and I'm like begging her and we're causing this whole scene and eventually I just had to give up like she was not going back in and especially because ⁓ now I'm remembering as soon as I brought her back
They were like, sorry, you discharged, her bed's gone. You have to go back through the ER. And at that time, the ER was like hours long wait to get another bed. So it wasn't like I could just get her in there and get her hooked on the meds. It was like, I would have to like do the whole thing again. I like, I remember bursting into tears. I remember my mom was like, yeah, I'm out of here. And she just left and we went home and I was so scared because the doctors were like, she's gonna die.
So I negotiated with her to at least see a doctor the next day. I was like, okay, if you're gonna leave now and not go through, you know, find another bed, please, can we see your doctor tomorrow morning, please? And luckily she agreed. And that was the scariest night because I remember her, she was sleeping. I was at the time texting with my best friend who is now my husband.
And I watched her all night and I couldn't sleep because the doctor was very clear that she could die at any point in the middle of the night, have a seizure and just like go into cardiac arrest and die. So I was watching her and then like the moment that we could go to the doctor, I took her back to the doctor and the doctor was like, yeah, your blood levels are awful. We need to take you to emergency room right now. And thankfully he made some phone calls and got us like.
a bed faster than we normally would have. I mean, that was a, you know, she's alive, she's sober, she's like, you know, like this is a, this is a good story. There are so many stories of people that I know who, especially if there's like psychosis or something on the line, they might take their loved one to a hospital in the ER and the, you know, their loved one just kind of like.
Some of them are like able to like pull it together in front of the doctors or able to say like, don't know. I don't know why they're so upset. I'm fine. I understand that. ⁓ I understand that I need help and, but yet like I'm not at risk to myself. I would like to go home. Thank you very much. And they're able to sound coherent and stable enough to go home. But then like they didn't disclose that they had like wild hallucinations or they try to hurt themselves like a, you know, a day ago, right? So it's.
It's scary for the family and friends around someone who is severely mentally ill and won't cooperate because it's like, for good reason, everyone has their own rights to choose whether they're in treatment or not. But sometimes that means that you have to watch someone choose whether they want to die or not. They go, no, I'm fine. I'm not going to hurt myself. And then they don't go to the hospital and they die.
or like my mom. it's just like, sometimes this is a situation of fighting against the person or to save them. So that was me as a kid. Now that I'm older, what I know now is, okay, let's say you have a loved one who is about to hurt themselves or you're just scared for them. ⁓ The go-to move is calling 911. ⁓ And that is great if you... ⁓
if that's like what you need to do when you're at risk and like that's a good way to prevent something bad from happening, but some things to remember. Calling the police can be really scary and traumatizing on its own. It helps to call 911 and say, I have a mental health crisis. I need someone trained in mental health to come and help us and be really, be really.
either gentle or calm and really calm and deescalate the situation. Because if people call them like, ah, know, like someone's gonna hit me, the officers might come in with force or just like, you know, like even sometimes they've used pepper spray or handcuffs in ways that are like very scary and jarring for everyone involved. So I say that this is a mental health crisis. The better option if you can, if you have,
access to this is 988, which is a mental health crisis line. this is a, this is a, in the US, this is a national resource where, and I think other countries have similar things, but I don't know what they are, but 988, you text it or call it, and they have trained providers that help deescalate situations. So they'll walk through your loved one through,
skills they could do to calm down, make themselves feel better or avoid a crisis. So that's 80 % of the cases that they'll help that person to kind of stabilize. ⁓ But then the 20 % is like when the crisis is like too much and you can't just calm someone down on the phone. And when that happens, they send a mobile crisis team, meaning that they will actually send someone to ⁓ take someone to a mobile crisis center or
the ER, the nearest ER. ⁓ If you can take your loved one to the ER yourself, that's obviously the best. But if none of those work, then you call 911 and call the police and say, I have a mental health crisis. Can you help me deescalate the situation and keep this person safe and describe exactly what's happening? So those are the different routes of where to call. 988.
taking them to the emergency room yourself or calling the police. So when all of those routes will take your left one to the emergency room. And keep in mind that when you take someone to the emergency room, it's not like you get necessarily help right away. Sometimes there's long waits, right? Because there's a lot of procedures involved. There's a lot of signing papers. And there's a lot of taking away any weapons on you, right? So there's like keeping like
all the different things that you need to do to get in. And then ⁓ you get a bed. ⁓ And what that looks like is it really ranges. mean, working the ER, was like we had these different rooms with beds and they were nice. But then also sometimes when things were overflowing, was just like beds everywhere, like the hallway and stuff. But we got people settled in.
side note, some people know this and abuse this, but it's a it's a decent way to get free juice and a snack, give you like sandwiches and juices. So there are actually some people who are high flyers of the ER who just like come in for you know, they're they're unhoused. So they like come in and they get like detox and they get a snack and they get to sleep somewhere for a night. So it's like, you know, ⁓ so it could be like a really lovely place first for some people who need it. But
⁓ The patient is usually in the beds and the loved ones are outside in the hallway. And I remember talking, like a lot of my job was assess, like going in, talking to the person, trying to understand why they're here and then getting collateral. So really understanding like, it's like a detective story. was like learning the pieces of the story and what happened. I loved that. I would work in the ER in a heartbeat. I would stay there. I loved it so much. It was like a puzzle. It was like,
Person who really need to help and you could get them help because he had like this whole amazing Hospital and then you were figuring out. Okay, what happened here? Like what is going on? So I Would do like a little interview with them interview with the with the you know family member who's like sitting outside terrified and It was really interesting and get like sometimes completely different stories people like the patients would say I don't know I don't I don't really know why I'm here
my friend just said that they were worried about me. And then when I would ask the friend questions, it would be like, yeah, I was eating lunch with them out in a restaurant and they started to hear voices. So they jumped up and they started to punch the people in the table next to us. And I was like, oh my God, you like you get these stories that the patient might not tell you right away or you call, you know, for their...
psychiatrist or maybe they were in the ER a couple of weeks ago and you get the full story. So that was my job in the ER. I loved it. And it was just so interesting to like see mental health patients from that like bigger scope, right? You usually only get the patient telling you everything, but this was like, wow, okay, I get their doctor and I get information from their mom and their partner. And it just gives so much of a fuller picture.
So, I mean, there was some, it was also kind of like, you saw everyone from walks of life come through. I mean, it was crazy. I saw like famous theater people who were really struggling during COVID. It was COVID at the time and kind of had like a nervous breakdown. There were some people who were living, living in a shelter and shelters are a really scary place, but they might've been abused or.
There was one woman who was living in a shelter and she was like, I don't know where I am. ⁓ I was in my room and I was talking to someone and I think they drugged me because I started to feel weird and now I don't remember anything and now I'm here and I don't know where I am. I don't know who I am. She was like really disoriented. And there was a lot of people with personality disorders, like my BPD folk. And it was just like,
It was like from every walk of life. There was even one, I can't even say, I can't say who it is without breaking the laws, but like one of my favorite bands, their lead singer was in our unit for a while, because ⁓ they went through a really ⁓ bad episode. ⁓ Drug induced. ⁓ The thing that I was surprised about was how common it was for
people to have different kinds of mental health episodes triggered by like regular drug use. And I don't mean the hard drugs, but I think it was, I think the rise of vaping and like THC and weed and vapes, it just, you know, it had a new, it was a new trend. And we were seeing a ton of people who just maybe had some mental health issues before, but like pretty much standard.
and started vape ⁓ THC and then was like hallucinating or had a psychotic break. ⁓ I think that's because I've been talking to other psychiatrists too and I think that's because the concentrations of TXC in these vapes are you know so so high higher than you know any other way of consuming it and ⁓ people when they vape they like take these big they they
They don't just have a puff and pass. They just are breathing it in, these high concentrations. And for anyone who might be vulnerable to mental illness, that could be super destabilizing. There's some people who are like, I've never had issues except for being a little anxious. And suddenly they were like manic or they were hallucinating or they were paranoid. And it might've triggered like a real manic episode. So people gotta be careful with them.
But the craziest story that I remember from the ER, I'm thinking about what details to hide. So it's not, you can't look this up. But I remember I walked in one day and the start of my shift and the night psychiatrist were really shaken up. And we were all debriefing about what was going on. And the psychiatrist was like, ⁓ so we have a patient here.
And the police came in and showed us pictures of ⁓ what he did. He had murdered a family member and we have graphic pictures of what he did. It was a stabbing. And the police are going to arrest him, but we have to make sure that he's safe, meaning we have to ask him if he understands what he did and what the consequences are.
because if anything happens, if he runs or hurts himself, then it's our responsibility to make sure that doesn't happen. So ⁓ I go in to the room with the rest of the psychiatrist to talk to this patient. The patient was ⁓ young, smart, handsome, articulate. ⁓
He was saying like, went, you know, it's like had some drug problems, COVID was really hard, college was really hard, ⁓ but he feels better now. He like had a couple overdoses and had a little bit too much cocaine, but like is now ready to turn a new leaf. And we kept asking questions about, like, we have these pictures of your family member, like.
murdered. So we couldn't feed it to him right away. were just questions to see if he would volunteer that information. He was handcuffed to the bed too, which is unusual. But he was very calm. He was very like, yeah, I've been having a really hard time and I know that...
Like you wouldn't even notice. And then finally after like an hour of trying to ask questions, the head psychiatrist was like, okay, I have to tell you that we've talked to the police. ⁓ They showed us some pictures. We know what you did. Do you remember doing that or do you acknowledge that? And he went, yeah, I did that. Yeah. Yeah, I did that. I did that a couple of days ago. Yeah. Really calmly.
And that was really a crazy moment for me because I expected something. I expected him to lash out. I expected something really scary to happen. it was just like if I asked him, did you have a banana the other day? He's like, oh, yeah. Yeah, I did that.
And so the psychiatrist were able to talk to him and he did seem to be very aware of what was happening and understand the consequences and was taken into custody after discharge. it was just, you know, it was just a shocking moment because you just really don't know, you know, people who you expect to be scary or dangerous and are not. And the people who were just like very calm and
coherent was, I don't know, that was just a crazy, crazy memory. ⁓
Let me see where.
I'm trying to remember, like I'm trying to pull all the points that my psychiatrist friends and I remember to remember about the ER. think one ⁓ thing to remember about the ER, sorry, let me cut out that part. so the ER is a really helpful place. could be scary, but what to know about is...
If you're a loved one, bring someone to the ER, to the hospital. Ask for a psychiatrist on staff, get an evaluation. It will take some time. You might have to wait. You might have to remove your stuff. Everyone might have to remove their stuff. They sit in the bed and they wait for a long time to talk to a doctor. But then the doctor will assess for the symptoms and they'll assess for how much is this person at risk, either of
an overdose or hurting themselves, but they're trying to assess like how, like what does this person need to stay safe? They might even offer, they might even give some medications to help stabilize. So ⁓ anti-psychotics or something to prevent ⁓ withdrawal from alcohol or even like mood stabilizers. So they'll like stabilize that person. So if you're like, my gosh, someone I know is having a psychotic break, bring them to the hospital and they will get them stabilized.
And then after that, go, if that person is at risk of hurting themselves, they'll hold them there for 72 hours, at least in New York. I don't know what is all the other states, but they'll hold them and then they'll make a decision about what is the best place to send them. So if they have their own treatment team, it's like sending them home with coordination with their care team or finding a detox center or inpatient hospital with an open bed, which is actually pretty hard.
⁓ So that's, it's like, okay, stabilize and then ⁓ refer to the best care. ⁓ It's not jail, it's not the, it's not, they're not in trouble. Like the people at the ER, they might be tired doctors, but they're there to keep that person safe. They're there to like, you know, to care for.
loved one. So I think sometimes people come in with a lot of fear and so they come combative like, oh, you can't take my phone and stuff and they're not taking your phone to be mean. doing it for safety.
Okay, so that is that's a little picture of what the emergency room looks like. So when you're, you know, calling for someone to taking them to the emergency room, that's that's where you go. That's like the worst case scenario here. But I'll walk through what it means to make a safety plan, ⁓ which has escalating steps up until bringing them to the ER. So I started with like the the biggest like, you know, the worst case scenario. This is like the biggest.
thing to do to help someone who has a mental health crisis. this, you can make a plan for what to do, ⁓ hold on.
But it's still really helpful to think about what are the actual steps that I'm gonna take if someone I love is going to get dysregulated or they're at risk. And I don't just mean if they wanna hurt themselves or something. You could use this way of thinking for any kind of major crisis or emergency or outburst that you're scared of. Like if your anxiety is going, listen to that anxiety and actually make a plan. Don't just spin in the what ifs.
I actually sit down and go, what would that look like? What would that worst case scenario look like? And what would I do to keep everyone safe? ⁓ When I work with patients who have a history of self harm, suicide, or overdose or anything, by default make a safety plan. So ⁓ I'll actually ⁓ link a safety plan to this. ⁓
to the show notes just so you have it so you can, you know, your worksheet you can write down and could help you figure out your safety plan. But here are the different components of a good safety plan. So even if you're just listening to this and just want to write this down, here's what, here's the steps to think about. One is warning signs of risk. How do you know that that person is getting dysregulated or is, or getting at risk? What are the behaviors or things that they do that signal to you, uh-oh. ⁓
This is not going to be safe. Two, make the environment safe. Meaning, if someone is dysregulated and there's anything in their environment that might be dangerous, maybe guns, knives, pills, figuring out a safe way to remove them during that crisis. So locking them up or bringing them to friends or just removing that person's access to them.
and then coping strategies. So this is like, can you do with them or what can they do to help ideally calm them down, make them feel better, but it could just be just to prevent them from doing something harmful, right? Just to like get through that moment. And a lot of distress tolerance skills from DBT are really helpful.
that I like to teach are the pace breathing skill, breathing in for a count of four and out for six. ⁓ So breathing out for longer than breathing in. ⁓ Putting your face in ice water and like a big bowl of ice water and putting your face in there. Really calm someone down quickly or an ⁓ ice compress on the forehead is really useful. ⁓ Or anything that that person does that helps them get through a tough moment, whether it's take a walk or call someone or.
You know, do a craft, something that gets them through that really hard moment. And then you could think about other people who can help, like social settings or actual people. ⁓ And that can mean anything from like, where is like a public place that I know that they could be safe, right? Like taking them to their favorite library or cafe that could be distracting, a support group is always great, or actual people. And this is something to really think about.
If you feel like their safety is all on you, then that's a real signal for you to think in advance who is going to help in that moment. It could be their friend, right? It could be a family member. It could be a neighbor. But someone who can do something to help, whether it's keep that person company, like just hang out with them for the night to make sure that they're safe, or take them to the movies, or talk to them, or...
take them to the ER if you're not available or if that doesn't work. thinking about who can help and really talking to those people in advance, right? It'd be like, hey, I'm worried about this person. I'm just thinking about what I'm going to do if ⁓ something scary happens. Do you mind if you just come over and help if it does, right? And then talking to the providers. So if that person, if your loved one has a
psychiatrist or psychologist, counselor, sponsor, just anyone. ⁓ And this is a, know, all the other stuff you could kind of, you know, think about on your own, but the best way to work with providers of your loved one is to like, actually figure out, okay, who should I call? Who do we call if there's an emergency? ⁓ Talk to your loved one about this, be like, hey, I know you're seeing a therapist and I've been worried about, you know, when...
things escalate and we have really bad conflict or if you were hurting yourself the other day, ⁓ is there a good way that I can reach out to your therapist? Or when would be a good time? how can we call your therapist when things get really scary? ⁓ Most of the time, loved ones will not wanna share that information, right? They wanna keep their therapist like private and away from you, which is tough. You can still...
reach out to their doctor or their therapist, they might not be able to respond back, but you could certainly share ⁓ information about what's going on. ⁓ And I want to be clear about something too. ⁓ If you reach out to your loved one's therapist, psychiatrist, or even talk to people in the ER, when you're describing what's happening with your loved one, try to keep it very factual.
there were so many family members who would be like, ⁓ he's always like this and he's just, he's dramatic and sometimes when he lashes out and they will like tell stories about the past and about their feelings and stuff like that. And, you know, like I totally understand they're like, like loving ones get upset too, but it's sometimes it's like, I just need to know what happened. So try to be really objective and be like, okay, you know, at 3.30 yesterday I noticed that ⁓ his hands were shaking and
you know, by this time they were saying that he was seeing something like be like, really describe the events that has been going on. So that's, know, if you talk to their care team, you just give like objective events about what's happening. And then the last, if none of those work, none of those help stabilize and keep that person safe, then that's when you start to call for emergency services. Again, 9-8-8, text or call, ⁓ take them to ER.
or call 911 and ask for an officer who can handle mental health crises and deescalate the situation. So I hope this was helpful because I think that even if you just plan these things in advance, hopefully you'll never have to use this plan. But in the moment of crisis, it is so hard to figure out what to do. It's so scary. It's...
and like you might be frozen, you might not be able to think. So actually writing these things out, keeping it on your phone, keeping it like somewhere safe and walking through the steps one by one so you're not relying on your brain when your loved one is like gonna hurt themselves or you. So making a safety plan can save lives and this could apply to not just when someone is like really at risk but even when someone just does something dumb like throw things when they're upset like.
What am I going to do? What are the signs of risk? How do I make the environment safe? What coping strategies can we do? Who can help? ⁓ What providers or professionals can help? what emergency services can be helpful at that point. So that's everything in a nutshell. So if you have any questions, please let me know. Leave it in the comments if you're watching this on.
YouTube or Spotify. can ask any questions in the comments. And if you can, leave us a five star review. Love you all. I want to hear from you. want to get some hear your feedback. But then I'll see you next week.