When someone near you is acting erratically, agitated, or disconnected from reality, your first job is to keep everyone safe, including yourself. How you respond in those moments, from your tone of voice to your physical positioning, can either calm the situation or make it worse. The approach depends on whether this is an acute crisis or an ongoing relationship with someone whose mental health is unstable.
Recognize What You’re Seeing
Before you respond, it helps to understand what kind of distress you’re dealing with. Someone in a manic episode may talk rapidly, seem full of restless energy, act impulsively, sleep very little, and express grandiose ideas about their abilities. They might pace, start multiple projects at once, or make risky decisions that are completely out of character. In more severe episodes, they can experience hallucinations or delusions.
Someone experiencing psychosis may seem confused, paranoid, or respond to things you can’t see or hear. Someone in a deep depressive crisis may be withdrawn, hopeless, or expressing thoughts about ending their life. And sometimes the person isn’t in a clinical episode at all but is simply overwhelmed, frightened, or feeling powerless. Each of these situations calls for a different level of urgency, but the core communication principles are the same.
Start With Yourself
Your own emotional state sets the tone for the interaction. If you’re visibly tense, the other person will pick up on it and escalate. Vanderbilt University Medical Center’s de-escalation framework starts with self-regulation: focus on your breathing for three breaths, relax your body, and soften your gaze. Remind yourself that the person in front of you is likely feeling scared, out of control, or disrespected.
Adopt a relaxed, open stance. Turn your body slightly to the side rather than squaring up face-to-face, which can feel confrontational. Keep your hands visible and open. Make gentle eye contact with a concerned expression rather than a hard stare.
Give Them Physical Space
When someone is agitated or anxious, their sense of personal space expands. What normally feels like a comfortable distance can suddenly feel threatening. Move slowly. Ask before entering their space, even if you think it should be obvious that you’re welcome. Stay clear of their arms and legs. In some situations, the opposite side of the room is close enough. Never touch their belongings without permission.
How to Talk to Someone in Crisis
Use their name. Find out what they prefer to be called and use it. This small act of respect can shift the dynamic immediately.
Keep your language simple. When someone is in acute distress, the emotional centers of the brain are firing hard, which makes it genuinely harder for them to process complex sentences. Use short phrases and repeat the same words rather than rephrasing. Changing your wording can create confusion and feel like you’re being inconsistent or dishonest.
Listen for the emotion underneath what they’re saying, not the specific story or complaint. Most people in crisis are experiencing some combination of fear, a feeling of being disrespected, or a loss of control. If you can name that feeling back to them (“It sounds like you’re feeling scared right now”), you validate their experience without having to agree with their interpretation of events. Allow silence. Let them vent without interrupting. Ask simple clarifying questions when there’s a natural pause.
If their behavior becomes dangerous or inappropriate, you can set limits calmly. Name the specific behavior (“You’re throwing things”), state it directly but without emotion, and use “when-then” framing: “When you sit down with me, then we can figure this out together.” The key is to stay matter-of-fact. Raising your voice, showing fear, or sounding judgmental will almost always make things worse.
What Not to Say
Certain phrases feel supportive but actually shut people down or escalate tension. Avoid these common mistakes:
- “You’ll be fine, don’t worry so much.” This feels dismissive, even when you mean it as comfort. Mental health crises aren’t about worrying too much.
- “There are people who have it much worse.” Comparisons encourage shame, not perspective. They don’t help anyone feel better.
- “You just need to think more positively.” This implies the person is failing at something that should be easy. Mental health challenges involve biological and psychological factors that can’t be overridden by attitude alone.
- “Have you tried yoga?” or “Why aren’t you on medication?” These come across as accusatory, as though the person hasn’t already considered obvious options. The decision to pursue treatment is theirs.
- “You’re just looking for attention.” This is one of the most damaging things you can say. It dismisses real pain and discourages the person from reaching out again.
- “You wouldn’t feel this way if…” Placing blame adds distress and doesn’t lead anywhere productive.
Instead, try staying with their experience: “I can see this is really hard for you” or “I’m here and I’m listening.” You don’t need to fix anything. Your presence and calm attention are doing more than you realize.
Use “I” Statements to Express Concern
When you need to address behavior or encourage treatment, framing matters enormously. “You need to get help” puts the other person on the defensive. “When I hear you talking about how unhappy you are, I feel worried” communicates the same concern without sounding like an accusation. “I” statements keep the focus on your own feelings and observations, which makes them much harder to argue with and much easier to hear.
This is especially important with family members who are resistant to seeking help. Pushing harder rarely works. Expressing your genuine concern, repeatedly and calmly over time, is more likely to eventually open a door.
Setting Boundaries Without Abandoning Them
Supporting someone with mental health challenges does not mean accepting harmful behavior. You can care about someone deeply and still draw firm lines around what you will and won’t tolerate. Being clear about your boundaries is not cruelty. It’s a form of honesty that ultimately benefits both of you.
Boundaries might sound like: “I love you and I want to help, but I can’t continue this conversation when you’re yelling at me. I’ll be in the next room when you’re ready to talk calmly.” The key is follow-through. A boundary you state but don’t enforce teaches the other person that your limits aren’t real. State it, act on it, and don’t apologize for protecting your own wellbeing.
When the Situation Is an Emergency
If someone is in immediate danger of hurting themselves or others, the situation has moved beyond what de-escalation alone can handle. You have several options depending on the severity.
The 988 Suicide and Crisis Lifeline is available 24/7 by call or text. It provides free, confidential support for people experiencing suicidal thoughts, emotional distress, or substance use crises. You can call on behalf of someone else or hand the phone to the person in crisis.
If there is an active physical threat, calling 911 may be necessary. Many areas now have mobile crisis teams or crisis intervention teams with behavioral health training that can respond to mental health emergencies. When you call, clearly describe the situation as a mental health crisis and ask whether a crisis-trained responder is available. This can lead to a more appropriate response than a standard law enforcement dispatch.
In the most serious cases, a person may be placed on an emergency psychiatric hold for observation, typically up to 72 hours. The general criteria for this include having a mental health condition with serious symptoms, posing an immediate safety threat, being unable to meet basic personal needs like eating or finding shelter, and being likely to benefit from hospital treatment. This process varies by state, but the core threshold is the same: imminent danger that cannot be managed any other way.
Protecting Your Own Mental Health
If you’re regularly supporting someone with severe mental health challenges, caregiver burnout is a real and common risk. The signs creep up gradually: exhaustion, resentment toward the person you’re caring for, emotional numbness, withdrawal from your own life. These aren’t character flaws. They’re the predictable result of sustained emotional labor without enough support.
Three strategies make the biggest difference. First, respite care: regularly handing off caregiving duties to someone else, even briefly, so you can recover. Second, joining a support group where others understand what you’re going through. Third, working with a therapist yourself, not because something is wrong with you, but because processing this kind of ongoing stress requires a dedicated outlet. If you ever notice resentment building toward the person you’re caring for, or if you feel you might be at risk of hurting them, reach out to a friend, family member, social worker, or mental health professional immediately. That impulse to reach out is not weakness. It’s the most responsible thing you can do.