Going to the ER for mental health

• A medical emergency alongside the crisis, like an overdose or injury
• Being unable to stay safe from acting on thoughts of suicide
• Confusion or very unusual behavior that could have a medical cause
• Someone being a danger to others
• No safer crisis option is available nearby

When there is no immediate danger to life, calling or texting 988 is a good first step. In many areas, mobile crisis teams and crisis centers aim to help people without an emergency room visit or hospital stay.

988 counselors can help you decide what level of help fits. If you are truly unsure whether someone is safe, it is better to go to the ER than to wait.

If you are very upset, try not to drive yourself. A trusted person can drive, keep you company in the wait and help you remember what staff say.

Call 911 for immediate danger to life, or if no one can get the person there safely. You can tell the dispatcher it is a mental health crisis.

In some areas, a mobile crisis team can come instead of, or alongside, police. See “Mobile crisis teams & crisis centers”.

In an emergency, go to the closest ER. If there is time and you have a choice, a hospital with a psychiatric unit may avoid a transfer later.

The evaluation usually includes lab work and a physical check, alongside an interview about what has been happening. This helps make sure nothing physical is being missed.

Staff may check belongings and store items like belts, shoelaces or sharp objects. They are returned when you leave.

You may talk with an emergency doctor first, then a mental health clinician such as a psychiatrist, nurse practitioner or social worker, in person or by video.

1. Breathe in through your nose for a count of four
2. Breathe out slowly through your mouth for a count of six
3. Name five things you can see and four you can hear
4. Press your feet into the floor and notice the feeling

• “Could I have some water or a blanket?”
• “Can you tell me what we’re waiting for?”
• “Is there a quieter place I could sit?”
• “I’m feeling worse. Can someone check on me?”

If you feel less safe, more panicky or physically unwell while waiting, tell the nearest nurse right away. You don’t need to wait for your turn to say so.

Things to share

• Any alcohol or drug use (staff need this for safety, not to judge)
• Any health conditions
• How long you have felt this way
• What happened today
• Whether you have thoughts of suicide or harming someone

If you struggle to explain, show them a note on your phone or let your support person help.

A psychiatric advance directive is a legal document, made while you are well, that records your treatment preferences and can name a trusted person to speak for you in a crisis.

Hospitals must let patients make advance directives and must follow them as the law allows.

You may go home with a referral to outpatient care, such as counseling or an intensive outpatient program.

In one large study, making a safety plan in the ER plus follow-up phone calls was linked to 45% fewer suicidal behaviors over six months.

The team may suggest inpatient care, and you may agree to it. See “What a psychiatric hospital stay is like”.

If professionals believe someone is at serious risk of harming themselves or others, state law may allow a short involuntary hold, most often up to 72 hours. Rules differ by state.

If a hospital can’t provide the care needed, or the patient asks, an appropriate transfer to another facility should be arranged.

Waiting for a bed can take hours, sometimes longer.

Hospitals with emergency departments that take Medicare must give a medical screening exam to anyone who asks for emergency care, regardless of ability to pay. They must provide stabilizing treatment, or an appropriate transfer.

You have the right to be told your rights, to take part in decisions, to privacy, to a safe setting and to be free from abuse. Restraint or seclusion may be used only for immediate physical safety, never as punishment or for convenience.

Hospitals must have a process for complaints. For help with bills, insurance and surprise charges, see “Paying for care & your rights”.

• Bring water, a charger and a snack for yourself
• Keep your voice low and steady
• Offer to speak up if they find it hard
• Stay with them unless they ask for privacy
• Write down names, instructions and next steps

You can tell staff what you noticed, even if privacy rules limit what they can tell you back. Family can give information, though professionals make the decisions about care.

Take breaks, eat something and call someone for your own support. 988 is there for worried family and friends too. See “Looking after yourself while supporting someone”.

• “You’re not in trouble. We’re here to help you feel safer.”
• “I’m staying right here.”
• “You can tell the doctor anything, even if it’s hard.”

Staff may ask to speak with your teen alone for part of the visit. This helps them speak freely and is a normal part of care.

• Do they need to stay, and where?
• How do we make our home safer tonight?
• What should we tell school?
• What signs mean we should come back?
• Who do we see next, and when?