When someone you care about is acting erratically, hearing things that aren’t there, threatening harm, or seeming disconnected from reality, your first job is to stay calm and keep everyone safe. What you do next depends on how severe the situation is: some moments call for a quiet conversation, others for professional crisis intervention. Here’s how to assess what you’re dealing with and respond effectively.
Recognize What You’re Seeing
Not every emotional outburst is a crisis. The difference between someone having a terrible day and someone in a genuine psychiatric emergency comes down to a few key indicators. These signs need immediate attention: threats to harm themselves or others, hallucinations or delusions (seeing or hearing things that aren’t there, or holding beliefs that don’t match reality), extreme withdrawal from normal life, not sleeping or eating for days at a time, and verbal or physical aggression.
In adults, watch for punching walls or getting into fights, giving away prized possessions, suddenly getting affairs in order, increasing alcohol or drug use, and abandoning personal hygiene. In younger people, the signs can look different: rapid mood swings, total isolation (refusing to leave their room), talking very quickly or nonstop, drastic changes in eating or sleeping habits, and irrational or confused thinking.
The behaviors you’re witnessing could stem from many different conditions. Someone in a manic episode, for instance, may experience grandiose delusions, hear voices, or show a level of energy and agitation that looks identical to a psychotic break from another cause. You don’t need to diagnose what’s happening. You need to know whether the person is safe right now.
How to Talk to Someone in Crisis
The way you communicate matters enormously. Keep your sentences short and simple. A person in crisis processes information slowly, so say one thing at a time, pause, and repeat if needed. Use a low, steady tone of voice. Before you respond to anything, listen to the full message, including body language. Resist the urge to interrupt, argue, or correct what they’re saying, even if it sounds irrational.
Respect personal space. Stay far enough away that the person doesn’t feel cornered or threatened, and never block a doorway or exit. If possible, sit down so you’re at their eye level rather than standing over them. Your posture and tone should communicate one thing: that you’re here to help everyone stay safe, not to control or overpower them.
A communication framework developed by psychiatrist Xavier Amador, called LEAP, is especially useful when someone doesn’t recognize that something is wrong with them. It stands for Listen, Empathize, Agree, and Partner. Start by genuinely listening to their experience without reacting emotionally. Then reflect back what you’ve heard to show you understand how they feel, even if you don’t agree with their interpretation of reality. Empathy doesn’t mean validating a delusion. It means acknowledging the fear, frustration, or confusion behind it.
Next, find any point of agreement, however small. Maybe you both agree they haven’t been sleeping well, or that the current situation feels overwhelming. If a conversation escalates into an argument, agree to pause and come back to it when emotions have cooled. That alone signals respect. Finally, frame any next step as a partnership: “Let’s figure this out together” rather than “You need to do this.” People experiencing mental health crises often feel isolated and frightened. Knowing someone is genuinely on their side can make the difference between cooperation and resistance.
Make the Environment Safer
If you live with someone who is unstable or you anticipate a crisis, take practical steps to reduce risk in the home. NAMI recommends storing all medications in a lockable cabinet or box, with special attention to sedatives and opioids. Lock up or remove alcohol, recreational drugs, sharp objects like knives and razors, and anything that could be used for self-harm: ropes, belts, long cords, lighters, and household chemicals.
Firearms are the most critical item to address. Remove them from the home entirely if possible. If you can’t, store them unloaded and locked, with ammunition locked in a separate location. Also consider securing windows on upper floors, restricting rooftop access, and keeping car keys on your person or hidden. These aren’t permanent changes to your life. They’re precautions that buy time during dangerous moments.
When to Call for Help
If someone is actively threatening to hurt themselves or someone else, or is so disconnected from reality that they can’t care for themselves, it’s time to involve professionals. You have several options, and the right one depends on urgency.
For immediate danger to life, call 911. Be clear with the dispatcher that this is a mental health emergency. Many areas now have co-responder programs that send a mental health clinician alongside or instead of police.
For situations that are serious but not immediately life-threatening, call or text 988. This connects you to trained crisis counselors available 24/7 for suicidal thoughts, mental health crises, and substance misuse emergencies. Live chat is available at 988lifeline.org. Veterans can press “1” after dialing to reach the Veterans Crisis Lifeline, or text 838255. Services are available in Spanish as well. In situations where emergency dispatch is needed, many 988 centers have direct relationships with local emergency services and can coordinate a faster response.
Mobile crisis teams are another option in many cities. These are mental health professionals who come to you, assess the situation in person, and help determine next steps. They’re designed for people who don’t need immediate hospitalization but do need more help than a phone call can provide. Mobile crisis teams can direct EMS or police to take someone to an emergency room involuntarily only if the person appears to have a mental illness and is a danger to themselves or others.
What Involuntary Commitment Actually Looks Like
One of the hardest situations is when someone clearly needs help but refuses it. Every state has laws allowing involuntary psychiatric evaluation, but the threshold is consistent: the person must have a mental illness and be a danger to themselves or others. The Supreme Court has recognized that involuntary hospitalization involves fundamental liberty interests, so states cannot commit someone simply for being mentally ill if they aren’t dangerous.
In practice, this means you typically can’t force someone into treatment because they’re acting strangely or making choices you disagree with. If you believe they’ve crossed the line into genuine danger, contact your local crisis services or go to your county’s mental health authority to learn the specific process in your state. Some states allow family members to petition for an involuntary evaluation. Others require law enforcement involvement. The process varies, but the legal principle is the same everywhere: danger, not just illness, is the threshold.
Protect Your Own Wellbeing
Caring for or being around someone in a mental health crisis is exhausting and sometimes frightening. Your safety is not secondary to theirs. Physical boundaries mean maintaining enough distance that you can leave if the situation escalates. If you feel threatened at any point, leave the room or the house and call for help from a safe location. You cannot de-escalate someone if you’re in physical danger yourself.
Emotional boundaries are harder to maintain but equally important. Being supportive doesn’t mean absorbing someone else’s crisis as your own. You can care deeply about a person and still recognize that you are not their therapist, their medication manager, or their sole reason for staying safe. Separating your own emotional needs from theirs isn’t selfish. It’s what allows you to keep showing up over the long term rather than burning out completely.
If you’re regularly supporting someone with a serious mental health condition, connect with a support group like those offered through NAMI (National Alliance on Mental Illness). Talking to people who understand exactly what you’re going through provides relief that’s hard to get anywhere else.