What Qualifies as a Mental Health Crisis?

A mental health crisis occurs when a person's emotional state, thoughts, or behavior put them at risk of harming themselves or someone else, or when they can no longer cope with daily life. Recognizing the difference between a difficult day and a genuine crisis is not always straightforward, but certain warning signs consistently signal that professional help is needed right away.

Warning Signs That Indicate a Crisis

Mental health crises show up differently from person to person, but several patterns reliably indicate that someone has moved beyond ordinary stress into dangerous territory. Watch for sudden, dramatic changes in behavior or mood. A person who has been withdrawn for weeks and suddenly becomes agitated, gives away possessions, or talks about being a burden may be signaling suicidal intent.

Other warning signs include inability to perform basic daily tasks like eating, sleeping, or maintaining personal hygiene. Severe confusion or disorientation that appears without a clear medical cause can point to a psychotic episode or a substance-related crisis. Hearing voices, expressing paranoid beliefs, or losing touch with reality are signs that require immediate professional evaluation.

Expressions of hopelessness carry particular weight. When someone says things like "there is no point anymore" or "everyone would be better off without me," treat those statements seriously. Research from the 988 Suicide and Crisis Lifeline shows that directly asking someone whether they are thinking about suicide does not increase their risk. It opens the door for an honest conversation that could save their life.

Suicidal Ideation: Passive vs. Active

Suicidal thinking exists on a spectrum. Passive suicidal ideation involves thoughts like "I wish I weren't alive" or "I wouldn't mind if I didn't wake up tomorrow," without a specific plan or intent to act. Active suicidal ideation involves thinking about specific methods, making plans, or expressing intent to die. Both forms warrant concern, but active ideation with a plan represents an acute crisis requiring immediate intervention.

The transition from passive to active ideation can happen quickly, especially when a person faces a sudden loss, a relationship breakdown, financial ruin, or acute intoxication from alcohol or drugs. Access to lethal means, particularly firearms, dramatically increases the risk that suicidal thoughts will become fatal actions. In Colorado, firearm-related deaths account for a significant portion of suicides, which makes safe storage counseling a critical component of crisis response.

Psychotic Episodes

Psychosis involves a break from reality that may include hallucinations, delusions, severely disorganized thinking, or extreme agitation. A person experiencing psychosis may hear voices that others cannot, believe they are being watched or controlled, or behave in ways that are completely out of character. Psychotic episodes can occur in the context of schizophrenia, bipolar disorder, severe depression, substance use, or extreme sleep deprivation.

During a psychotic episode, the person often does not recognize that anything is wrong. They believe their experiences are real. This makes self-reporting unreliable and places responsibility on people around them to recognize what is happening and seek help. Approaching someone in psychosis requires patience and calm. Avoid arguing with delusions. Instead, focus on their safety and contact a crisis team or emergency services.

Severe Panic and Acute Anxiety

Panic attacks, while not always classified as psychiatric emergencies, can escalate into crises when they are prolonged, recurrent, or when the person believes they are dying. Symptoms mimic serious medical events: chest pain, difficulty breathing, numbness, and a sense of impending doom. A person experiencing their first severe panic attack often ends up in an emergency room convinced they are having a heart attack.

Panic becomes a crisis when the person cannot be calmed, when attacks occur repeatedly over hours, or when the fear of another attack leads to dangerous behavior like fleeing, self-medicating with substances, or refusing to leave a location. Chronic, untreated anxiety disorders also raise the risk of substance misuse, as people turn to alcohol or benzodiazepines to manage symptoms on their own.

When to Call 988

The 988 Suicide and Crisis Lifeline is the national number for mental health crises. Call or text 988 when someone is expressing suicidal thoughts, engaging in self-harm, experiencing severe emotional distress they cannot manage, or showing signs of psychosis. Trained counselors assess the situation by phone and can dispatch mobile crisis teams to the person's location in communities where those services exist.

The 988 line is appropriate for situations that are serious but not immediately life-threatening. It connects callers with local crisis centers staffed by people who understand the behavioral health resources available in their region. For families in Western Colorado, knowing about the crisis intervention process ahead of time makes it easier to take action when a moment of crisis arrives.

When to Call 911

Call 911 when there is immediate physical danger. That includes active suicide attempts, a person who has ingested a dangerous amount of drugs or alcohol, violent behavior directed at others, or any situation where someone's life is at immediate risk. Emergency medical services can provide life-saving interventions that crisis counselors cannot.

There is overlap between 988 and 911 situations, and no one should feel guilty about calling the wrong number. Both systems can redirect callers as needed. If you are uncertain which to call, err on the side of calling 911 when physical safety is in question. Understanding the different types of mental health crises can also help you gauge the appropriate level of response.