As I settled into my seat on the “L” train last week, my attention was drawn to a woman opposite of me. It was apparent she was grappling with challenges; her soft murmurs filled the space as she occupied three seats, her gaze was lost in the cityscape beyond the window. The signs of hardship were evident: unwashed for days, her shoes worn and ill-fitting, accompanied by a persistent, raspy cough.

She departed a few stops later, yet her presence lingered in my mind. I reflected on the countless individuals I’ve encountered across Chicago—on public transit, in stores, parks, and street corners—each battling significant mental health issues. These encounters stirred a deep compassion within me, but also a sense of unease. Interacting with someone in the agony of acute psychosis, who may exhibit unusual behaviors or experience hallucinations, can be daunting. Their distress is perceptible, and the uncertainty of how to assist can be paralyzing.

In my own experiences, I’ve grappled with the fear of exacerbating a delicate situation or doubted my ability to make a meaningful difference. The prospect of intervening in a public setting adds another layer of complexity.

Fortunately, organizations like Mental Health First Aid USA offer invaluable training to equip the public with the skills to handle such crises.

In this blog, I aim to weave my personal experiences with actionable guidance from their training. My hope is that these insights will empower you with the knowledge and confidence to offer support when you next encounter someone in mental distress.

Prioritizing Safety in Crisis Situations

Assess Your Safety: Begin by evaluating your own sense of security. Your intuition about safety is paramount; never compromise your well-being. If you sense danger, it’s imperative to distance yourself from the situation and contact emergency services by dialing 911. When speaking with the operator, provide a clear description of the individual’s behavior and request the assistance of a mental health professional. Informing the operator about any intoxication or weapons involved is also crucial. While the presence of law enforcement may escalate tension, do not hesitate to seek help during emergencies. Your goal should be to safeguard everyone involved, including the person in crisis, yourself, and bystanders.

Evaluating the Individual’s Safety: Often, a person experiencing acute psychosis poses a greater risk to themselves than to others. Conversely, aggressive behavior is frequently linked to substance abuse. If there’s any indication of self-harm or threats to others, treat it as a mental health emergency and call 911 immediately.

If you feel safe, and you do not believe the person is at risk of harming themselves or others, you can attempt to de-escalate the situation. However, if you are unable to de-escalate the agitated person you should always call for help. You can let the agitated person know who the unfamiliar people are and that they are there to help.

Effective De-Escalation Strategies

Remain Calm and Empathetic: Approach the individual with a serene demeanor and a compassionate voice. Introduce yourself and express your intent to assist. Ask open-ended questions like, “What can I do to help you feel secure?” Be mindful of your body language; avoid any gestures that might be perceived as anxious or confrontational.

Offer Choices and Space: Empower the person by providing options. Ask if they would prefer you to call someone, sit quietly with them, or assist in another way. Honor their requests when safe to do so, such as adjusting your position or giving them room to move. Always be conscious of your own safety and keep a clear path to an exit.

Instill Hope and Suggest Professional Support: Convey your commitment to their safety and reassure them that there are professionals who can offer further assistance. Encourage them by asking about past experiences that have helped them cope, or if they have a healthcare provider they trust to contact.

Reach Out

In any crisis, prioritize safety first. If you decide to engage, do so with calmness and without judgment. Offer practical support, encourage professional help, and provide reassurance. Remember, your intervention can be a beacon of hope during a challenging moment.

Please consider reaching out today and starting your journey with a therapist.