Definition

A mental health emergency is any disturbance in thoughts, feelings, or behaviour which requires immediate attention to avert serious outcomes to self or others.

Patients may attend the mental health emergency setting voluntarily on their own, may be brought by families/friends or through involuntary commitment.

Examples of mental health emergencies and clinical presentation

1. Violent behaviour
2. Suicidal behaviour
3. Psychosis
4. Drug/Alcohol intoxication
5. Personality disorders

Violent behaviour

Violence can be caused by many factors. People who are emotionally distraught, angry, or have extreme nervousness or sadness, may be violent. Medical condition such as delirium with various underlying physical causes and drugs may also cause violence besides other symptoms such as disorientation, memory impairment and mood changes.

Suicidal behaviour

The warning signs of suicide are change in behaviour such as withdrawal from friends and families, lost interest in daily activities, expressing a wish to be dead, history of previous suicidal attempts, showing self-destructive behaviour and making plans to end life.

Psychosis

Patients with psychosis are often seen at the emergency department. The patient will show peculiar or inappropriate behaviour and may be seeing visions or hearing voices when alone. They may have false beliefs of being harmed by others or commanding voices telling them to harm others. They may also harm themselves.

Drug/Alcohol intoxication

Intoxication to drugs or alcohol may result in behavioural changes that may cause injury or death. Individuals who are intoxicated may be talkative, socially disinhibited, have impaired concentration, memory, motor performance and judgement. Both drugs and alcohol can also cause psychotic symptoms.

Personality disorders

Those with personality disorders show dysfunction in areas related to thinking, emotions, interpersonal relationship and impulse control. They may be involved in arguments with others or show uncontrollable behaviour that upset others.

What to do in a mental health emergency

Patients should be brought to the nearest health centre or hospital and police help may be needed to bring patients who are aggressive, unmanageable or those who are of threat to self or others, to ensure the safety of the patient and others.

Treatment

Treatment of mental health emergencies are transitory with the main aim being to stabilize the patients after which they will be referred to the appropriate setting. Patients should be properly assessed and attempts should be made to ‘talk it-out’ first before giving any medication.

‘Talking therapy’/Crisis intervention

When patients are overwhelmed by stressful events they are said to be in crisis and help for them is called crisis intervention. In crisis intervention patients are given support, allowed to express their distress and if possible to discuss problem solving.

Medication

Medication may be needed to calm patients if they are very restless, aggressive or psychotic. Oral medication may be tried first if the situation permits. However if rapid action is needed injections may be given. Patients normally can be controlled within minutes after the injections.

Hospital admission

The patients will be thoroughly assessed to decide if admission is required. The main reason for psychiatric admission is when the patient is of danger to self or others. They may also be referred to other settings for further management if necessary.

Conclusion

Patients with mental health emergencies require immediate attention. Urgent intervention needs to be given as some of the conditions are very serious and potentially life threatening. The patients can be brought to the nearest health care facility for treatment.