RECOGNIZING A MENTAL HEALTH CRISIS

While it is important to recognize that warning signs are not always present when a mental health crisis is developing, evidence that a person is experiencing a mental health crisis may include:

• Rapid mood swings (being suddenly depressed and withdrawn to being suddenly happy or calm)
• Talking about suicide
• Increased agitation (inability to stay still, pacing, irritability, excessive talking, problems with staying focused or conversing)
• Inability to perform daily hygiene tasks
• Angry outbursts
• Talking about or making verbal threats
• Paranoid thinking
• Abusive behavior to self or others, including substance use or self-harm
• Isolating from school, work, family, and friends
  (NAMI, 2020)

When an individual in crisis is found to be imminently threatening harm to self or others, the crisis has now become a life-threatening situation, and a mental health emergency exists. Evidence that a person is experiencing a mental health emergency may include:

• Acting on a suicide threat
• Severe disorientation
• Evidence of psychosis (losing track of reality, inability to recognize family or friends or to understand what others are saying, hallucinating)
• Homicidal or threatening behavior
• Self-injury requiring immediate medical attention
• Severe impairment by drugs or alcohol
• Highly erratic or unusual behavior indicating unpredictability to safely care for self
  (UH, 2020)

Being aware of various risk factors may alert clinicians to patients facing a potential mental health crisis. Likewise, an individual experiencing a crisis may have physical and psychological as well as interpersonal signs and symptoms.

Contributing Risk and Protective Factors

Factors that can increase the risk for mental health crisis include:

• Family history of mental health problems
• Presence of or history of mental illness
• History of abuse or traumatic event
• Being bullied or bullying others
• Poor academic achievement
• Presence of concurrent illness or injury
• Use of alcohol or drugs
• Poor nutrition, chronic pain, lack of sleep
• Presence of other stressful life events
• Low self-esteem, negative self-perception
• Lack of emotional awareness
• Belief in an outside locus of control
• Recent loss (e.g., death, divorce)
• Lack of social support
• Pessimistic outlook
• Poverty

Factors that can decrease the risk for mental health crises include:

• Having access to a reliable support system
• Emotional self-regulation
• Good coping and problem-solving skills
• Subjective sense of self-sufficiency
• Optimistic outlook
• Positive self-regard
• Good peer relationships
• Economic/financial security
  (AMWA, 2020)

It is important to remember that mental health crises can arise due to mental illness or medical conditions such as:

• Diabetes (low blood sugar)
• Hypoxia
• Traumatic brain injury
• Decreased cerebral blood flow
• Central nervous system infections (meningitis)

Signs and Symptoms of Stress in Adults

Signs and symptoms of emotional distress may occur before or after a crisis. Most symptoms are temporary and will resolve on their own. However, for some, these symptoms may last for weeks or even months and may influence their relationships with families and friends.

Physical

• Sleep disturbances
• Generalized aches and pains
• Tension headaches
• Intestinal cramps, diarrhea, heartburn, constipation
• Muscle tension, fatigue, cold hands and feet, sweaty palms
• Shortness of breath, chest pain, tachycardia, hyperventilation
• Loss of libido
• Increased vulnerability to colds, flu, infections

Psychological

• Anxiety, fear, racing thoughts
• Irritability
• Constant worrying
• Feeling hopeless and helpless
• Impatience
• Poor judgment
• Feelings of doom
• Depression

Behavioral

• Eating disturbances
• Increased conflict and arguing
• Isolation from social activities
• Neglecting responsibilities
• Using alcohol and/or drugs to relax
• Job instability related to conflict with coworkers and employer
• Road rage
• Domestic or workplace violence
• Nervous habits (e.g., nail biting, pacing)
  (Segal et al., 2020)

Signs and Symptoms of Stress in Children and Adolescents

At each stage of development there are unique responses. In children and adolescents, the responses may differ from those of an adult. In younger children, the following may occur:

Physical

• Decreased appetite, changes in eating habits
• Headache
• Nightmares
• Sleep disturbances
• Upset stomach or vague stomach pain
• Other physical symptoms with no physical illness

Emotional and Behavioral

• Routinely expressing anxiety, worry
• Crying
• New or recurring fear or displaying fearful reactions
• Clinging behavior to parent or teacher
• Emotional lability
• Aggressive or stubborn behavior
• Regression back to younger behaviors (e.g., thumb-sucking, bedwetting)
• Withdrawal from family or school activities

Adolescents in crisis may experience or exhibit the following:

• Generalized anxiety rather than specific fears
• Decrease in academic performance
• Poor concentration
• Increased aggression and oppositional behaviors
• Abandoning long-time friendships for a new set of peers
• Expressing hostility toward family members
• Out-of-control anger and frustration
• Increased risk-taking behaviors
• Substance abuse and alcohol use
• Moodiness and social withdrawal
• Use of denial as a coping mechanism
  (Kaneshiro, 2018; APA, 2020)