RECOGNIZING A MENTAL HEALTH CRISIS

It is important to recognize that warning signs are not always present when a mental health crisis is developing. The most common sign of crisis is a clear and abrupt change in behavior. Evidence that a person is experiencing a mental health crisis may include:

• Sudden changes in mood
• Agitation
• Aggressive behaviors
• Confused thinking or irrational thoughts
• Verbally stating, writing, or insinuating a desire to hurt one’s self or others
• Talking about death or dying
• Extreme energy or lack of energy
• Changes in ability to complete daily tasks
• Withdrawing from typically attended social situations
• Changes in diet, not eating or eating all the time
• Hallucinations, delusions, or paranoia
• Losing touch with reality
• Self-harming behaviors
• Unexplained physical change, such as weight loss or gain
• Sudden poor academic behavior or performance
• Sleeping problems
• Changes in social habits, such as withdrawal or avoidance of friends and family
• Increased substance use (drugs or alcohol)
  (Crisis Response, 2023)

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
• The person appears at risk to evolve into one of the above situations
  (Zeller, 2021)

Contributing Risk and Protective Factors

Risk and protective factors may be biophysical, psychological, social, or spiritual in nature, as described in the table below.

RISK AND PROTECTIVE FACTORS FOR MENTAL CRISES

Category	Risk Factors	Protective Factors
(AMWA, 2023)
Biophysical	Family history of mental health problems Complications during pregnancy or birth Personal history of traumatic brain injury Chronic medical conditions such as cancer or diabetes, especially hypothyroidism or other brain-related illnesses such as Alzheimer’s or Parkinson’s Use of alcohol or drugs Poor nutrition and lack of sleep	Secure attachment as a child
Psychological	Stressful life situations, such as financial problems or breaking the law Traumatic life experiences such as rape or serving in the armed forces Low self-esteem, perceived incompetence, negative view of life Poor academic achievement	Reliable support and discipline from caregivers Following rules at home, school, work Emotional self-regulation Good coping skills and problem-solving skills Subjective sense of self-sufficiency Optimism Positive self-regard Focus on making healthy food and beverages choices
Social	Being abused or neglected as a child Being in an abusive relationship or friendship Having few friends or few healthy relationships Recent loss, either by death, divorce, or other means Bullying, either as the victim or perpetrator Growing up in or currently living in poverty Poor social skills, poor communication skills Discrimination Lack of access to support services	Ability to make friends and get along with others Good peer relationships Supportive relationship with family Participation in sports, club, community, or religious group Economic/financial security Access to support services
Spiritual	Perception of being irredeemable or inherently flawed beyond repair Perception of insignificance Conflicting thoughts or doubts surrounding deep religious beliefs	Future orientation Achievement motivation Set of moral beliefs

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)
  (PsychGuides, 2023)

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 family and friends. They may include:

Physical

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

Cognitive

• Memory problems
• Inability to concentrate
• Poor judgment
• Seeing only the negative
• Anxious or racing thoughts
• Constant worrying

Emotional

• Depression or general unhappiness
• Anxiety and agitation
• Moodiness, irritability, or anger
• Feeling overwhelmed
• Loneliness and isolation
• Other mental or emotional health problems

Behavioral

• Eating more or less
• Sleeping too much or too little
• Withdrawing from others
• Procrastinating or neglecting responsibilities
• Using alcohol, cigarettes, or drugs to relax
• Nervous habits (e.g., nail biting, pacing)
  (Segal et al., 2023)

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.

When a younger child (1–12 years) is experiencing stress, the following signs and symptoms may be evident:

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
• Inability to relax
• New or recurring fear or displaying fearful reactions
• Clinging behavior to parent or teacher
• Emotional lability
• Anger, crying, whining
• Aggressive or stubborn behavior
• Regression back to younger behaviors (e.g., thumb-sucking, bedwetting)
• Withdrawal from family or school activities
  (Kaneshiro, 2022)

Adolescents in crisis may experience or exhibit the following:

• Anger or irritability
• Frequent crying or tearfulness
• Withdrawal from activities and people
• Abandoning long-time friendships for a new set of peers
• Poor concentration
• Expressing hostility toward family members
• Neglecting responsibilities
• Decrease in academic performance
• Increased risk-taking behaviors
• Complaints of headaches or stomachaches
• Lethargy
• Uses drugs or alcohol
  (Vorvick, 2022; APA, 2022)