Prompt professional or emergency evaluation may be appropriate for worsening Psychosis symptoms:

If someone is experiencing rapidly worsening psychosis, dangerous behavior, inability to care for themselves, or thoughts of harming themselves or someone else, prompt professional or emergency evaluation is appropriate.

A mental health emergency is a situation in which a person’s psychological or behavioral state has deteriorated to the point that there may be an immediate risk of harm, severe impairment, or inability to care for basic needs. The priority is safety, stabilization, and appropriate professional intervention, not diagnosing the person in the moment.

Signs that may indicate an emergency:

1. Imminent suicide or self-harm risk

Expressing an intention or plan to die or seriously harm themselves

Accessing or preparing means for suicide

A recent suicide attempt

Saying others would be better off without them

Giving away possessions or making final arrangements

2. Risk of violence

Specific threats toward another person

Severe agitation or escalating aggression

Access to weapons combined with threats or impaired judgment

Inability to respond to reasonable attempts at de-escalation

3. Severe psychosis

Extreme disorganization or inability to communicate coherently

Hallucinations or delusions accompanied by dangerous behavior

Severe paranoia resulting in attempts to escape, attack, or defend against perceived threats

Profound loss of contact with consensual reality

Importantly, having hallucinations or unusual beliefs alone does not automatically mean someone is dangerous or experiencing an emergency. Risk should be assessed based on behavior, intent, judgment, and circumstances.

4. Severe mania or behavioral dysregulation

Extreme agitation or impulsivity

Little or no sleep for an extended period

Grandiosity accompanied by dangerous behavior

Reckless spending, driving, sexual behavior, or other high risk actions

Severe impairment in judgment

5. Severe inability to care for oneself

Not eating or drinking adequately

Extreme confusion or disorientation

Wandering or becoming lost

Being unable to obtain essential medication or shelter

Profound deterioration in functioning

6. Altered consciousness or unusual behavior with a possible medical cause A sudden behavioral change may result from delirium, intoxication/withdrawal, medication effects, neurological illness, infection, metabolic problems, or other medical conditions. A first episode of severe confusion or bizarre behavior therefore warrants medical assessment rather than assuming it is psychiatric: consult with a Neurologist/Psychiatrist.

How to respond effectively

1. Stay calm.

Use a low, slow, non-confrontational voice. Avoid arguing, threatening, crowding, or attempting to “prove” that the person’s perceptions are wrong.

2. Establish immediate safety.

Ask directly when appropriate:

“Are you thinking about hurting yourself or someone else?”

3. Reduce stimulation:

Move to a quieter environment when possible. Reduce unnecessary people, noise, and confrontation.

4. Listen without validating potentially dangerous beliefs.

You may validate the emotion without confirming the belief:

“That sounds frightening. I can see that you’re very concerned. Let’s focus on keeping you safe.”

Rather than:

“Yes, those people really are following you.”

5. Do not leave someone alone when there is imminent danger.

If safe to do so, remain with the person while emergency assistance is obtained.

6. Involve appropriate professionals.

Depending on severity, this might include a mental health crisis team, clinician, mobile crisis service, emergency department, or emergency medical services.

7. Treat medical emergencies as medical emergencies.

If there is overdose, serious injury, unconsciousness, severe confusion, seizure, difficulty breathing, or another potentially life threatening condition, CALL 911.

In the United States:

For an immediate life threatening emergency, call 911 or go to the nearest emergency department.

For suicide, self-harm, or emotional crisis support, 988 provides the Suicide & Crisis Lifeline. The person does not necessarily need to be suicidal to contact 988; it may also be used for significant emotional or behavioral crises.

A possible useful mental health principle:

A mental health emergency is best conceptualized through risk, impairment, urgency, rather than simply through the presence of a psychiatric symptom:

What is happening?

How impaired is the person?

Is anyone in immediate danger?

Could there be a medical/substance related cause?

If someone is experiencing rapidly worsening psychosis, dangerous behavior, inability to care for themselves, or thoughts of harming themselves or someone else, prompt professional or emergency evaluation is appropriate.

Shervan K Shahhian