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 Centre for Addictionand Mental Health |
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Getting Help
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10.6 When a crisis becomes and emergencyA Family Guide to Concurrent Disorders - Part III: Treatment Outline - Chapter 10: Crisis and emergency
If your relative threatens to harm him- or herself or you, or to seriously damage property, you must do whatever is necessary to protect yourself and others (including your relative) from harm. You may need to leave and call for help. This is advisable only under extreme circumstances, and only for very short periods of time. If possible, remove objects that your relative could use to harm him- or herself. Don't:
SuicideOne of the most terrifying aspects of a serious mental health disorder is talk of suicide. Any talk—or even joking—about suicide must be taken seriously. Most people do not want to end their lives. Suicidal thinking or attempts typically occur during a serious episode of mental illness when the person feels helpless, hopeless and in a state of despair. Although the feelings are often temporary, at the time, people do not believe that the feelings will pass. You can help by acknowledging your relative's feelings while offering to help him or her find other solutions. However, it is also important to recognize your own limitations. Family members must realize that they do not have absolute control to change things and cannot be responsible for all of their relative's actions. Warning signs of suicide There are several warning signs that a person is considering suicide. He or she may:
What to do if you find someone after a suicide attempt:
Do not try to handle the crisis alone; contact a support group to help you with your immediate reactions and long-term feelings. Getting treatment in an emergencyGoing to the hospital It's best if you can get your relative to go to the hospital voluntarily. If he or she won't listen to you, ask someone your relative trusts to convince him or her to go to the hospital. This should be part of your prearranged action plan (see “Creating an Emergency Plan,” p. 174. Try to offer your relative a choice. For example, John's mother might have asked him: “Will you go to the hospital with me, or would you prefer to go with your father or Anna?” This reduces a person's fear that he or she is being coerced. Calling the police If your relative appears likely to endanger him- or herself or someone else, and refuses to see a doctor, you can get a judge or justice of the peace (depending on the province or territory in which you live) to issue a document that authorizes the police to take your relative to a hospital for an assessment. But if you're in a crisis or emergency situation (the danger is immediate), just call 911. Sometimes you have to phone the police, and the first time is really tough. I remember the first time we had to phone 911, and the ambulance came, and the police—and then my neighbour who's a doctor came over and said, “Is there anything I can do?” And I had to say, and I remember I actually got it out, “My daughter is having a psychotic episode. And she's been using crack.” And once I got that out, he was very supportive—and I was fine. I thought, OK, you know, that's behind me. So I told him, and he was very kind. So once you put it out there, and nothing terrible happens, you're OK. It's understandable that families are reluctant to call the police, but extreme circumstances may leave you no other choice. Often, merely telling the ill person that you are calling the police will calm him or her down. When you call 911, tell the emergency operator that your relative needs emergency medical assistance and give the operator your relative's diagnosis. Say you need help getting him or her to the hospital. In some communities, the police are given training in crisis intervention. It's helpful to find out what kind of training, if any, the police in your community have so you'll know in advance how much advocating you might have to do when and if you need to call on them. If you find yourself in a situation where you need to call the police, write down the officers' names, badge numbers and response time in case you later need to report any concerns about how the problem was handled. While the police are present, you may have time to call the doctor or any other emergency contact. Even when your relative has been destructive or physically abusive, you may be reluctant to involve the police. Family members sometimes fear that their relative will be put in custody where they may be victimized and treated inappropriately. But failing to take seriously the risk of violence and physical harm can have its own consequences. You should take care to recognize the signs of escalating threats and violence, and the presence of extra stress and triggers that could set your relative off, and know when things are beyond your control. Don't be afraid to call a crisis team in to your home or the police. In many cases that is the safest, kindest thing you can do for an ill family member. Involvement with the forensic mental health system Ironically, if a person with serious mental health conditions comes before a judge because he or she has been charged with doing something illegal, it may be more likely that person will be remanded for a full assessment and possibly treatment. Forensic psychiatry is a branch of mental health that works with people who have become involved with the law. For some individuals with mental health problems who have become involved with the law, being directed to a forensic facility allows them to receive the care that they have not been able to receive in the community system. The forensic mental health system can be confusing for families. If you live in Ontario, The Forensic Mental Health System in Ontario: An Information Guide will help you find your way through the system. Working with emergency room staffIf possible, go to the emergency department with your relative. The staff should interview you because you have information that they need to decide how to treat your relative. If the emergency room staff don't ask to talk to you, you should insist that you get a chance to talk to them. Try to provide an organized account of the events leading up to the hospital visit. If you are worried about your safety should your relative be released, let the staff know. Involuntary admissionsIn some cases, your relative may not want to get treatment after a crisis, or even after having serious symptoms. In Canada, people can't be forced to get treatment for a mental health disorder unless they are a threat to themselves or others. While this approach does acknowledge the rights of the individual, it has created complex problems for families. If a person who doesn't want to be admitted to hospital is admitted, he or she is considered an involuntary patient. The specific criteria used to decide whether a person can be admitted to the hospital without his or her consent vary from province to province. The basic principles are:
If the person meets the provincial criteria for involuntary admission, a physician can issue a document that authorizes a short stay in the hospital (in most provinces, one to three days) for emergency treatment. In some provinces, another document must be issued if longer-term treatment is needed. Consenting to treatment People who have been admitted to hospital involuntarily still have the right to make decisions about their treatment if they are mentally capable to do so. This includes refusing treatment. To be considered capable, a person must:
If the person is not able to give informed consent, then he or she must be declared incompetent. Someone is appointed to make decisions on the person's behalf. In some provinces, the decision-maker is a family member while others use people appointed by the state. Information about the Mental Health ActEach province has its own Mental Health Act, so the rules vary from province to province. Provincial offices of the Canadian Mental Health Association (CMHA) and websites of provincial ministries of health are sources of information. Here are some useful links:
A Family Guide to Concurrent Disorders Part I: What are concurrent disorders? 1. Introduction to concurrent disorders Part II: The impact on families 4. How concurrent disorders affect family life 5. Self-care 6. Stigma Part III: Treatment 7. Navigating the treatment system 8. Medication Part IV: Recovery 11. Recovery 12. Resources |
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Last updated: Apr 16, 2008 5:49 PM Published: Mar 19, 2010 6:25 PM ID#P35324 |