Mental health emergencies are medical emergencies. They can be fatal — suicide claims more lives annually than road traffic accidents in most high-income countries. Panic attacks can mimic heart attacks so closely that the person having one genuinely believes they are dying. Untreated psychosis leads to self-harm, harm to others, and prolonged suffering. Trauma responses, if left unaddressed in the hours and days after a disaster, can develop into lasting conditions that impair recovery.
Yet mental health crises are the emergencies that bystanders feel least equipped to respond to. The fear of saying the wrong thing, of making things worse, of not knowing what to do — these are understandable. This guide addresses them directly: not with clinical jargon, but with practical, evidence-based actions that any person can take.
Psychological First Aid — The Foundation
Psychological First Aid (PFA) is the evidence-based framework for initial crisis support. Developed by the WHO, Red Cross, and leading psychological trauma researchers, it is designed to be delivered by non-clinicians in the immediate aftermath of a distressing event.
PFA is built on five core actions:
1. Look
- Assess the safety of the person and the environment
- Observe obvious distress, disorientation, or immediate safety concerns
- Identify people who may be in acute need (confused, alone, extremely distressed)
2. Listen
- Approach calmly and respectfully
- Introduce yourself and ask if the person wants support
- Listen without judgment or interruption
- Do not rush to give advice, reassure, or fix — the act of being heard is itself therapeutic
3. Link
- Connect the person to practical information, support services, or social connections
- Help them think about next steps
- Facilitate contact with family or friends if appropriate
4. Protect
- Shield from additional stressors where possible
- Create a calmer physical environment if you can
- Manage onlookers who may increase distress
5. Care for Yourself
- Supporting someone in crisis is emotionally demanding
- Acknowledge your own reactions; seek support after the interaction
Responding to Suicidal Ideation
Suicidal thoughts exist on a spectrum from passive ("I wouldn't mind if I didn't wake up") to active ideation with a specific plan. Any expression of suicidal thinking should be taken seriously.
Ask Directly
One of the most persistent myths in suicide prevention is that asking about suicide plants the idea. This is false. Research consistently shows that asking about suicide does not increase risk — it often provides relief to someone who has been unable to voice their thoughts.
Ask directly: "Are you having thoughts of suicide?" or "Are you thinking about ending your life?"
If the answer is yes:
- Stay calm and stay present — do not react with alarm or pull away
- Listen without judgment — resist the urge to argue, minimise, or immediately problem-solve
- Assess immediacy:
- "Have you thought about how you would do it?"
- "Do you have access to [method they described]?"
- "Are you planning to do this now, today?"
- Remove access to means if immediately possible — firearms, stored medications, other lethal means. This single action is one of the most effective suicide prevention interventions known. If the person has a firearm, work toward having it removed from the immediate environment.
- Do not leave the person alone if the risk appears immediate
- Call emergency services for anyone with an active plan and immediate intent
⚠️ Expressions of suicidal intent should always be taken seriously. "They probably won't do anything" is a dangerous assumption. It is far better to over-respond than to dismiss a genuine crisis.
What Not to Say
- "You have so much to live for" — minimises the person's pain
- "Other people have it worse" — invalidates their experience
- "You need to think about your family" — adds guilt without addressing the pain
- "Just pull yourself together" — not how mental illness works
What To Say
- "I'm glad you told me"
- "I'm not going anywhere"
- "This sounds incredibly painful. Tell me more about what's been happening."
- "You don't have to face this alone."
Panic Attacks
A panic attack is a sudden surge of intense fear accompanied by severe physical symptoms. It is not dangerous, but it is terrifying — particularly the first time. People regularly call emergency services during panic attacks because they believe they are having a heart attack.
Symptoms:
- Rapid heartbeat (palpitations)
- Chest tightness or pain
- Shortness of breath
- Dizziness or lightheadedness
- Tingling in hands, feet, or face
- Feeling of unreality or detachment (derealisation)
- Overwhelming fear, often of dying or "going mad"
Panic attacks typically peak within 10 minutes and resolve within 20–30 minutes.
Responding to Someone Having a Panic Attack
- Stay calm yourself — your calm communicates safety
- Speak slowly and quietly — "You're safe. I'm here. This will pass."
- Do not crowd them — give physical space
- Ground them with their senses — "Can you feel your feet on the floor? Take a slow breath with me."
- Guide controlled breathing:
- Breathe in through the nose for 4 counts
- Hold for 4 counts
- Out through the mouth for 6 counts
- Hyperventilation during panic maintains and worsens symptoms by lowering carbon dioxide — controlled breathing restores balance
- 5-4-3-2-1 grounding technique: Ask the person to name 5 things they can see, 4 things they can touch, 3 sounds they can hear, 2 things they can smell, 1 thing they can taste. This anchors attention to the present sensory environment.
- Do not tell them to "calm down" — this is ineffective and adds pressure
⚠️ If this is a first episode, if symptoms include significant chest pain radiating to the arm or jaw, or if the person does not improve within 30 minutes, call emergency services. Heart attacks and panic attacks can be extremely difficult to distinguish without ECG.
Acute Psychosis
Psychosis involves loss of contact with shared reality — typically through hallucinations (hearing voices, seeing things), delusions (fixed false beliefs), or severely disorganised thinking.
Psychosis can occur in the context of:
- Established psychiatric conditions (schizophrenia, bipolar disorder)
- First-episode psychosis in young adults
- Drug-induced psychosis (stimulants, cannabis in high concentrations, hallucinogens)
- Medical conditions (high fever, severe electrolyte imbalance, delirium in elderly people)
Responding to Acute Psychosis
- Prioritise safety — assess whether the person's behaviour poses a risk to themselves or others; call emergency services if there is any immediate risk
- Be calm and non-threatening — do not shout, rush, or make sudden movements
- Do not argue with delusions — saying "that's not real" or "there's no one there" is unhelpful and can increase agitation; instead acknowledge distress: "It sounds like you're having a frightening experience"
- Speak simply and clearly — short sentences; calm tone; slow pace
- Reduce environmental stimulation — move to a quiet, less crowded space if possible
- Do not leave alone if there is any safety concern
- Identify if they have a support person or know their mental health team — many people with chronic psychotic conditions have a care coordinator or crisis line
Deescalation Principles
For any agitated or distressed person, regardless of cause:
- Match their emotional level with calm, not with your own anxiety
- Use open body language — no crossed arms; turn slightly sideways rather than directly facing
- Validate the emotion without validating the specific content of delusions
- Give the person some control: "Would you like to sit down, or would you prefer to stand?"
Trauma Response
People who have experienced or witnessed a traumatic event may show immediate trauma responses:
- Shock, numbness, or emotional flatness
- Disorientation or confusion
- Distress and crying
- Physical reactions (trembling, nausea)
- Withdrawal
In the immediate aftermath:
- Ensure physical safety and basic needs — shelter, warmth, water are the foundations for psychological stability
- Do not push for the person to process the event — narrative trauma processing immediately after a critical incident can worsen outcomes for some people; do not demand or encourage them to "talk about it" if they are not ready
- Social connection — being with familiar people is strongly protective; facilitate family reunification or connection with trusted people
- Practical support — help with immediate problems (finding children, contacting family, obtaining food) demonstrates care and reduces helplessness
- Watch for acute stress reactions that may require professional referral within days: flashbacks, inability to sleep or eat, extreme numbness, complete inability to function
When to Escalate
Call emergency services or immediately connect the person to crisis services when:
| Situation | Response |
|---|
| Active suicidal intent with plan | Emergency services; stay with person |
| Active self-harm in progress | Emergency services; first aid for wounds |
| Immediate risk to others | Emergency services |
| Agitated psychosis with safety risk | Emergency services |
| Loss of consciousness | Emergency services; CPR if needed |
| Severe disorientation and confusion (medical cause possible) | Emergency services |
| Intoxication combined with suicidal statement | Emergency services |
Quick Reference
| Crisis Type | Do | Do Not |
|---|
| Suicidal ideation | Ask directly; stay present; remove means; call for help | Minimise; leave alone; promise secrecy |
| Panic attack | Calm presence; slow breathing; grounding | Crowd; say "calm down"; ignore cardiac symptoms |
| Psychosis | Non-threatening tone; do not argue with delusions; call services if unsafe | Shout; argue; leave alone if safety risk |
| Trauma response | Safety; basic needs; connection; practical help | Force narrative processing; project expected emotion |
This guide provides general Psychological First Aid information for non-clinical bystanders and first responders. It is not a substitute for professional mental health care. If you or someone you know is in crisis, contact emergency services (999/911) or a crisis line. Many countries provide 24-hour crisis support — know your local number before an emergency.