Mental health emergencies

Our approach to mental health emergencies

If you or a loved one has a mental health emergency, we will do our best to help you by arranging an urgent appointment with a Psychiatrist who can help you manage the situation. All of our Psychiatrists have extensive experience in helping people through mental health emergencies.

Mental health emergencies are outside of your control so you should never feel guilty, embarrassed or ashamed of asking for help. No matter what your problem is we will treat you with dignity and respect, ensuring a safe, confidential and empathetic environment to talk about any problems.

What is a mental health emergency?

Mental health emergencies can occur at any time of the day or night. Sometimes there is a trigger (for example, an argument with your partner). However, sometimes they happen out of the blue, similar to panic attacks.

A mental health emergency can take the form of a crisis, an emotional breakdown or a period of feeling suicidal. It is extremely important to reach out to a family member, a trusted friend or a professional if this occurs. Or if you start to notice any warning signs, reaching out before it happens could mean avoiding the emergency altogether.

If you are worried about a relative or someone close to you, then you might be better at noticing the warning signs than they are. If you start to notice anything unusual or strange about their behaviour, you can reach out to us for advice. It is possible to book an appointment with a Psychiatrist to discuss concerns about a relative or a loved one. In these cases, all the information is confidential, and you do not need to provide us with the details of this person. In these cases, we will help you understand the situation and will suggest ways to deal with it.

What are the signs of a mental health emergency?

The symptoms of a mental health emergency can differ depending on the person and circumstances. Here are some examples of things you may experience if you need urgent mental health care:

• Worried that you might hurt yourself
• Having thoughts that you might harm someone else
• Feeling like you can’t cope or can’t bear it anymore, feeling like “throwing the towel”
• Having suicidal thoughts, even if they are very brief. Or researching methods to do it.
• Hurting yourself in some way, such as cutting or burning your skin (self-harm)
• Feeling like you are about to die, or that you would be better off dead
• Feeling like you can’t trust anyone
• Having distressing emotions
• Having intrusive, repetitive thoughts that cause you distress

• Experiencing extremely upsetting flashbacks or visions
• Hearing distressing voices in your head
• Feeling like you have lost control
• Engaging in dangerous and reckless behaviour, or in impulsive behaviour like spending large amounts of money, gambling excessively or anything that could damage your health or cause problems
• Feeling like you are addicted to alcohol, drugs, sex or something else and that you are in a crisis situation or need urgent help
• Feeling very paranoid, confused or frightened about what is going on around you

How do you help with mental health emergencies?

Over the phone

• Provide expert advice depending on your situation and symptoms
• Recommend medication or arrange an appointment
• Arrange regular phone calls to check on you
• Arrange for a family member or someone else to check on you
• Contact NHS Services who can put you in contact with the local Crisis Team or Emergency Services, as appropriate

Long-term help

• Assessment and diagnosis of your symptoms.
• A personalised treatment plan designed for your unique circumstances and symptoms

Treatment plans could combine psychotherapy (psychological talking therapy), medication, stress-reduction techniques or lifestyle intervention (nutrition, exercise and sleep)

How can the London Psychiatry Clinic help me with a mental health emergency?

You can ring us on 020 34 888 555 to speak to a member of our team. Our lines are open Monday-Friday 8am to 10pm.

If we think you would benefit from seeing one of our Psychiatrists, we will arrange an urgent appointment for you. Following the emergency psychiatry assessment, the Psychiatrist will be able to admit you if appropriate, or may offer other treatment options.

If the Psychiatrist thinks that you may require an admission into a psychiatric hospital, they will discuss this with you. Some of our Psychiatrists have admitting rights to the Nightingale Hospital and we can generally arrange this within 24 hours, depending on the availability of beds. If you prefer to be admitted to a different hospital (such as the Cardinal Clinic or one of the priory Hospitals, for example), we can help you connect with them.

How can I get help out of office hours?

If our lines are closed, you can choose the most appropriate urgent mental health care option for your situation:

• Attend the nearest A&E department
• Call NHS 111
• Contact your GP who may be able to assist you (some GP practices offer out of hours support)
• Samaritans offer a 24-hour telephone helpline calling 116 123
• Call 999 if you need an ambulance
• if you believe you require an urgent admission to the Nightingale Hospital, call Reception 020 7535 7700 and ask for the Duty Doctor to discuss your situation; please note it is a private hospital so you would need to check your cover with your health insurance if you are not self-funded as the NHS will not cover the admission

What is sectioning?

In very extreme circumstances, a doctor may decide that their patient requires sectioning. This simply means that they will make a decision on your behalf to commit you to an NHS facility to help you, such as a psychiatric hospital. Both a NHS Psychiatrist as well as a private Psychiatrist can section a patient.

If a Psychiatrist, GP or family member has serious concerns about somebody’s mental health, they need to contact the local, Approved Mental Health Professional (AMHP) who will arrange for a Mental Health Act Assessment.

A Mental Health Act Assessment is a meeting where the approved mental health professional (often a social worker or a mental health nurse) will carry out an assessment of the individual, together with one or two Psychiatrists. The purpose of the assessment is to understand whether the individual is suffering from a mental health condition that would put them at risk of harming themself or someone else. They also consider whether or not their mental health problems will get significantly worse if they don’t receive urgent mental health care and treatment urgently.

After the assessment, the Psychiatrist will provide a recommendation to the Approved Mental Health Professional (AMHP) as to whether they think the individual should be admitted to hospital and sectioned under the Mental Health Act. The final decision to section a person will be made by the approved mental health professional as per the Mental Health Act. Generally, most people are admitted to hospital under a Section 2.

It is very important to understand that a person will only be admitted to hospital involuntarily, using the powers of the Mental Health Act if the AMHP is seriously concerned following the assessment. Both the AMHP and the Psychiatrist will endeavour to discuss every alternative option, engaging with the home treatment team.

Once a person is made aware that they may be sectioned, they have the opportunity to be admitted voluntarily. Please bear in mind that you will not be sectioned unless you are extremely, mentally unwell to the extent that you can’t make rational and safe decisions for yourself.

Sectioning is done as a safety measure to protect someone from harming themselves or others. Under the Mental Health Act 1983, a psychiatrist has the capacity to section their patient if they have completed the requisite training. There are different types of sectioning, depending on the specific situation and the severity of the symptoms.

What is a welfare check?

A welfare check, also known as a wellness check, is when a member of the police goes to an individual’s home to check on their wellbeing.

If you, or someone you love, is having a mental health emergency then a welfare check may be a safe and responsible way to escalate it.

Before contacting the police to request a welfare check, you will need to be confident that the person you are concerned about is definitely acting in a way that worries you and that they may be in need of urgent help. For example, if you believe somebody may have taken an overdose of medication.

How do I request a welfare check?

• If you think the situation is urgent and requires immediate action, then you should call 999 or attend your nearest A&E
• If you don’t think the situation is immediately urgent, you can call the local police station in your area
• If you are unsure of the correct police force for your catchment area, you can always call 101 or NHS 111 and request a welfare check that way

What happens after a welfare check?

If the individual you requested a welfare check for is found safe and well, then the police may choose to notify you and no further action will be taken.

If the police arrive to perform their welfare check and discover a need for urgent medical assistance then they will ring 999 if an ambulance is needed, and you will likely be notified and may be asked to provide further input or support.

What is a panic attack?

A panic attack is a sudden wave of emotions where you feel extremely fearful and panicked. It is an exaggerated, bodily response to fear. These can arise either unprompted, or as a result of something stressful happening in your environment. Although it can feel incredibly overwhelming, a panic attack isn’t a mental health emergency because they are usually brief. In some instances, people can experience recurrent attacks, which is panic disorder.

During a panic attack somebody may experience any of the following symptoms:

• Overwhelming feelings of dread and fear, almost like a sense that you are just about to die
• Raised heart rate, palpitations
• Tightness on your chest, feeling like you’re having a heart attack
• Excessive sweating, especially in the palms
• Trembling, shaking or shivering
• Shortness of breath, sometimes feeling like you are choking
• Out of body experiences or feeling disconnected from yourself

I think I’m having a panic attack, what do I do?

Panic attacks can be frightening or overwhelming. Each person’s panic attacks will be uniquely triggered by their own particular fears. For example, some people may experience panic attacks as a result of being in a big crowd of people, while others may have a panic attack because they’re afraid of being alone.

A panic attack is simply an exaggerated fear response. When the body perceives a threat a message is sent to the brain. When people experience a frightening situation, such as a panic attack, they will experience a reaction called the Flight-Fight-Freeze” response. This means that humans have evolved to either take flight and escape the frightening situation, fight off the oncoming threat or freeze into inaction. When someone has a panic attack, they don’t usually feel like they can escape or fight the panic attacks so the most common reaction is usually the ‘freeze’ response. This is why some people may feel unable to think, speak or even move appropriately when they have a panic attack.

While the emotional and physical experience of a panic attack can be deeply unsettling, it’s important to know that panic attacks are common and can be treated.

If you think you might be experiencing a panic attack, it is important that you speak to a friend or someone you trust to explain what is happening.

If you’re certain that you’re having a panic attack, there are several strategies that could help to reduce some of the immediate symptoms. However, we always recommend consulting your GP, doctor or therapist to let them know that you’re struggling with panic attacks.

Some strategies that could help include:

1

Take yourself to a calm, quiet place where you can focus solely on yourself and your breathing

2

Taking long, slow deep breaths, ensuring that your exhale is longer than your inhale

3

Reorientate yourself in the situation, take a moment to reconnect with your thoughts

A panic attack will generally pass after a few minutes, but in some cases it can take up to several hours.

Am I having a panic attack or a heart attack?

Although a heart attack is very different from a panic attack, when a panic attack strikes it can sometimes be confused for a heart attack. If in doubt, contact emergency services who can discuss your symptoms with you over the phone and send an ambulance if needed.

Here are some of the key differences to look out for:

Specific panic attack symptoms:

• Can happen while you’re resting
• Palpitations
• Breathing fast but still feeling breathless
• Dread, fear and impending doom
• Symptoms tend to resolve within 20 – 30 minutes
• Tingling in extremities or in other areas such as your lips

Specific heart attack symptoms:

• Can happen anytime, whether you are resting or doing something
• Pain and pressure in the chest, which can radiate up the arm, jaw or shoulder blades
• The pain tends to increases in intensity and can last hours
• If it is severe, it can cause the person to lose consciousness
• Sweating profusely
• Feeling or being sick

Can a panic attack kill me?

A panic attack cannot kill you, even though it may feel like it can. Usually people find that their panic attacks will subside after 30 minutes maximum, with no long-term problems once the attack has finished. A small percentage of people may develop a panic disorder, which is where recurrent panic attacks occur, but there’s no increased risk of death as a result of panic disorder.

What is the difference between a panic attack and an anxiety attack?

In general, an anxiety attack is less intense than a panic attack. It might also last longer than a panic attack, with feelings of anxiety creeping up slowly and is usually caused by an anxiety-inducing event or situation.

In contrast, a panic attack is usually accompanied by very strong feelings of fear and a sense of unreality, which can arrive as a burst of intense emotion in the body. Panic attack symptoms typically disappear within half an hour (but not always). Panic attacks can seem random and without obvious triggers, whereas an anxiety attack is usually prompted by a perceived stressor or threat.

An anxiety attack can cause the individual to feel extremely uncomfortable or distressed, but to a lesser degree and is overall more manageable in the moment that it occurs.

What triggers a panic attack?

Everyone has different triggers. What makes one person panic, could be of very little significance to another. One person’s panic attack may be sparked because they are distressed about having said the wrong thing, whereas another person’s panic attack could be because they’re convinced they left the front door unlocked. Furthermore, panic attacks can appear without warning or any obvious trigger. If you are experiencing panic attacks, we advise that you contact your GP and someone close to you who you trust. It might also be helpful to keep a small diary and note when the panic attacks happen to see if there is any pattern to the attacks.

What is a mental breakdown?

A mental breakdown, also called a nervous breakdown, is a term used to describe severe emotional distress and anguish. It is a blanket term used when someone’s emotional difficulties are inhibiting their ability to function in normal life.

A mental breakdown can be caused by many things, we usually see them as a product of severe anxiety, depression or burnout.

What is mania or having a manic episode?

Mania is a period of excessively high mood or energy, usually associated with Bipolar Disorder. Mania can last for days, weeks or months.

During a manic episode the individual experiencing it is unlikely to recognise that there is a problem, even if those around them are trying to convince them. This often makes it very difficult to help the person. Even people who have been diagnosed with Bipolar Disorder and have experienced manic episodes in the past may not be able to recognise the symptoms of mania when they experience another episode.

A person with mania can experience any of the following symptoms:

• Higher than normal energy levels
• Sleeping less hours than usual for several days in a row but still feeling very well
• Feeling restless and unable to stay still
• Increase self-esteem, feeling grandiose and/or having very high confidence
• Being easily distracted from simple tasks
• Being extremely talkative
• Having lots of new ideas, plans and thoughts
• A racing, busy mind that is hard to tame
• Embarking upon multiple new projects with no realistic capacity to finish them
• Increased sexual drive
• Behaving in an overfamiliar way, and in a way that is out of character
• Actively engaging in dangerous or risky behaviours, such as impulsive sex
• Spending far more money than usual or gambling

Generally, mania is followed by a period of depression and so it is important to treat it as a way to mitigate the potential consequences of the manic episode and reduce the risk or intensity of the depression if it happens.

Hypomania can also occur, which is a lesser degree of mania but with a similar rise in energy and mood. This is generally seen more commonly in Bipolar II Disorder.

Someone I know has psychosis, should I be afraid?

“Psychotic” is a term often used in a derogatory, colloquial fashion. We may have heard people say “they are a total psycho” or “when they found out, they turned psychotic.” The film ‘American Psycho’ does little to remedy our prejudices about psychopathology, depicting a blood lusting killer driven by delusional thinking.

In reality, a psychotic person is far more likely to hurt themselves than they are to hurt someone else. Psychotic episodes and psychoses are a highly distressing, disorienting experience for the individual and they are in no way indicative of a personal failing on the sufferer’s part.

This makes it even more important that you support this person as best you can and seek appropriate help if you believe they are displaying any symptoms of psychosis.

What is a psychotic episode?

A psychotic episode is where an individual sees, hears, feels or smells things that are not there. The technical terms are visual, auditory, tactile or olfactory hallucinations. Psychosis is also characterised by delusions, which is where the individual believes things that are not true. Delusions are most commonly seen in people with schizophrenia, severe depression or during manic episodes. Each individual will experience different psychosis symptoms, but common reports of psychotic episodes include people feeling like they are:

• Convinced they are hearing voices that others can’t hear
• Caught up in their own world or thoughts, which are out of touch with reality
• Hypersensitive to their inner environment
• The unshakeable belief that someone or an organisation is spying on them or coming to do them harm
• Difficulty concentrating
• Mistrust of loved ones and people around them which can lead to social withdrawal
• Isolated with their thoughts

Am I having a psychotic episode?

A psychotic episode is where a person cannot tell what is imagined and what is real, which makes determining whether you are having a psychotic episode very difficult.

Psychosis does not usually appear without warning, it is usually caused by a specific mental health condition, drug overdose or an extremely traumatic situation or experience.

There are a few warning signs that someone could be experiencing an episode of psychosis, but only a trained mental health professional can accurately assess whether someone is having a psychotic episode.

What are the warning signs of psychosis?

• Seeing, hearing, smelling or tasting things that others don’t
• Feeling passionately attached to beliefs or ideas that they can’t be persuaded from, in spite of reasonable suggestions from family, friends or doctors
• Detaching from friends and family
• Feeling suspicious or mistrustful of people you previously trusted
• Coming across as very flat, lacking emotions
• Neglecting self-care or hygiene
• Finding school or professional work extremely difficult to concentrate on
• A significant, unexplained drop in performance at work or in school
  

Where can I get other support (financial or otherwise)?

• If you are struggling with a mental health emergency, you can find people to talk to and support at MIND Charity
• If you are struggling with homelessness, you can contact a charity called: Shelter
• If you need emotional support, you can call the Samaritans
• If you are in financial or practical difficulty, you can contact the Citizens Advice Bureaux (CAB) to discuss any benefits you may entitled to