If someone experiencing a mental health crisis becomes physically violent toward you, your first priority is your own safety. That means creating distance, calling for help, and using only the force necessary to protect yourself. Everything else, including getting the person help, filing a report, and processing what happened, comes after you are safe.
Recognize the Warning Signs Before an Attack
Most violence doesn’t come out of nowhere. The CDC identifies a progression of cues that signal someone is moving from agitation toward physical aggression. Verbal cues include yelling, swearing, and a threatening tone. Physical cues include clenched fists, heavy breathing, pacing, a fixed stare, and an aggressive posture. A terrified look can also signal danger, because fear-driven aggression is common during psychotic episodes or extreme paranoia. The more of these cues you observe at once, the higher the risk.
Sudden behavioral changes are particularly important to watch. Someone who shifts from agitation to eerie calm, or from withdrawn silence to loud hostility, may be on the verge of acting out. Signs of intoxication alongside these behaviors raise the risk further.
Try De-escalation If You Can Do It Safely
When someone is escalating but hasn’t yet become violent, and you have enough physical distance to feel safe, verbal de-escalation can sometimes prevent an attack. The American Association for Emergency Psychiatry outlines a set of principles that apply whether you’re a professional or a bystander.
Keep your hands visible and unclenched. Stand at an angle rather than directly facing the person, which feels less confrontational. Avoid prolonged eye contact or staring, as an agitated person can read that as aggression. Bend your knees slightly so you can move quickly if needed.
Use short, simple sentences. An agitated person may struggle to process complex language. Repeat key phrases: “You’re safe here. You’re safe here.” If the person seems frightened, match their urgency while staying calm. Introduce yourself by name if there’s time, and ask how they’d like to be addressed. This small gesture gives them a sense of control, which is often what a person in crisis has lost.
You can set limits without being aggressive. Saying something like “I want to help, but I can’t focus when you’re pacing toward me” is direct without being threatening. If necessary, calmly state that hurting someone is not acceptable and could lead to arrest. But if the person is already swinging, throwing objects, or charging at you, de-escalation is no longer the right tool. Get out.
Protect Yourself During an Active Attack
Your legal right to defend yourself does not disappear because the attacker has a mental illness. Self-defense law across the United States allows you to use force when you reasonably believe it is immediately necessary to protect yourself from someone else’s use of unlawful force. The attacker’s mental state is not a factor in your right to act. In many states, including Texas and others with “stand your ground” provisions, you have no legal duty to retreat if you are in a place where you have a right to be, you did not provoke the confrontation, and you are not engaged in criminal activity.
That said, the force you use must be proportional. You can block, push, restrain, or strike to stop the attack. Deadly force is legally justified only when you reasonably believe it is necessary to protect yourself from deadly force, or to prevent murder, sexual assault, kidnapping, or robbery. In practice, this means: do what you need to do to get safe, then stop. Courts evaluate whether your response was reasonable given the threat you faced in that moment.
If you can escape rather than fight, escape. Put furniture, doors, or walls between you and the person. Lock yourself in a room. Leave the building. Once you are physically safe, call 911.
What to Say When You Call 911
When you call for help, tell the dispatcher that the person appears to be in a mental health crisis. Many cities now have co-response teams that pair a police officer with a mental health clinician. In Indianapolis, for example, these Mobile Crisis Assistance Teams monitor dispatch calls for behavioral health indicators and can self-deploy. Some areas route mental health calls to dedicated crisis lines. Mentioning that the person seems to be experiencing a psychiatric episode, not just that they’re being violent, increases the chance that responders trained in crisis intervention will be sent.
If your area doesn’t have co-response teams, police will respond as usual. Either way, stay on the line with the dispatcher and follow their instructions about where to wait for responders.
Document Everything Afterward
Once you are safe, document the incident as thoroughly as possible. Write down the date, time, location, and how long the attack lasted. Record exactly what the person did to you and what they said. Note how you felt and list any witnesses. If you have visible injuries, photograph them yourself before seeking medical care, and photograph any property damage.
When police arrive, ask them to photograph your injuries and include the photos in their report if they don’t do so on their own. At the hospital, healthcare providers are trained to ask privately about how your injuries happened and to document the results. Request that medical staff photograph your injuries for your file as well. Having both a police report and medical documentation creates a record that matters for any legal steps you take later.
Filing for Protective Orders or Involuntary Evaluation
If the person who attacked you poses an ongoing danger, you have two distinct legal avenues. The first is a standard protective order (restraining order), which you can request through your local court regardless of the person’s mental health status. A protective order requires the person to stay away from you and can include other conditions like no contact by phone or online.
The second avenue is requesting an involuntary psychiatric evaluation. In nearly every U.S. state and most countries, a person can be held for emergency psychiatric assessment, typically 72 hours, when they pose a danger to themselves or others due to a mental disorder. The specific phrasing varies by jurisdiction. California requires that the person be “dangerous to self or others.” Washington state adds “danger of physical harm from failure to provide for essential human needs.” In Canada, provinces like Quebec and New Brunswick use similar “danger to themselves or others” standards with a 72-hour assessment window.
You do not need to be a medical professional to start this process. In many jurisdictions, any adult with personal knowledge that someone poses a danger can file an application. In Harris County, Texas, for example, anyone over 18 can request a court order for mental health services through the county clerk’s office. A physician must then certify the need within 24 hours of admission, a probable cause hearing happens within 72 hours, and a full mental health hearing follows within about eight days. You typically don’t need to be present at the initial hearings.
Taking Care of Yourself After the Attack
Being attacked by someone in a mental health crisis can leave you with a complicated mix of emotions: fear, anger, guilt, and confusion about whether you should feel sympathy for the person who hurt you. These reactions are normal, and the guilt in particular can delay people from seeking help for themselves.
Assault can lead to post-traumatic stress symptoms including flashbacks, hypervigilance, difficulty sleeping, and avoidance of places or situations that remind you of the attack. Several therapy approaches have strong evidence for treating trauma after assault. Cognitive behavioral therapy focused on trauma helps you process the event, build relaxation skills, and gradually confront the fear and avoidance that develop afterward. EMDR (eye movement desensitization and reprocessing) uses guided eye movements while you focus on the traumatic memory, helping your brain reprocess the event so it becomes less distressing over time. Psychodynamic therapy takes a longer view, exploring how the experience affects your relationships, emotional patterns, and sense of safety.
You don’t need to wait until symptoms become severe. Starting therapy early, even a few sessions, can prevent acute stress from hardening into chronic PTSD. If you were assaulted by someone you know, such as a family member or someone you care for, a therapist experienced with interpersonal violence can help you navigate the additional complexity of maintaining or ending that relationship while protecting yourself.
If This Happens at Work
Healthcare workers, social workers, teachers, and others in caregiving roles face a higher risk of being assaulted by someone with a mental illness. OSHA identifies several environmental risk factors that make attacks more likely: poor lighting, blocked escape routes, and lack of emergency communication systems. If your workplace doesn’t have a violence prevention program that includes hazard identification, environmental controls, safety training, and incident recordkeeping, that is a systemic failure, not a personal one.
After a workplace assault, file an incident report with your employer in addition to any police report. You are entitled to medical treatment through workers’ compensation for injuries sustained on the job, including psychological injuries. Document everything the same way you would for any assault: dates, times, what happened, witnesses, and photographs of injuries.