When someone you love is coming apart, the hardest part is often not knowing whether what you’re seeing is a rough patch or an emergency. They’ve stopped answering texts. They haven’t slept in days. And you’re left guessing at how worried you should be.
You’re not overreacting by paying attention. According to SAMHSA’s National Survey on Drug Use and Health, 23.4% of American adults — about 61.5 million people — experienced a mental illness in 2024. Crises are common, they’re survivable and the people closest to someone usually see one coming first.
If you or someone you know is in immediate danger, call 911 or go to the nearest emergency room. For a suicide, mental health or substance use crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. The National Rehab Hotline at 866-210-1303 is for non-emergency information, support and referrals.
What a Mental Health Crisis Looks Like
A crisis is any moment when someone’s distress outpaces their ability to cope. It doesn’t require a diagnosis, and it doesn’t always look dramatic. Sometimes it looks like withdrawal so complete the person has effectively disappeared.
Changes in Behavior
- Withdrawing from friends, family, work or things they used to care about
- Sleeping far more or far less than usual
- Neglecting hygiene, meals or responsibilities they normally manage
- A sudden increase in drinking or drug use
Changes in Mood and Thinking
- Talking about being a burden, being trapped or having no reason to keep going
- Extreme mood swings or sudden calm after a long period of despair
- Confusion, disorganized speech or trouble following a conversation
- Hearing or seeing things others don’t or beliefs that don’t match reality
The warning signs that matter most are changes from the person’s own baseline. You know what they’re normally like — trust that. Our mental health hotline page covers the underlying conditions in more depth.
In adolescents, irritability, falling grades and sudden social changes often show up before anyone mentions feeling depressed. If you’re worried about a teenager, our teen support resources cover the overlap between adolescent mental health and substance use.
What to Do in the Moment
You don’t need the right words. You need to stay in the room.
- Ask directly. If you think someone may be considering suicide, ask plainly. Asking doesn’t plant the idea — it usually does the opposite, telling the person their pain is visible and giving them permission to stop pretending.
- Listen more than you talk. The instinct to fix or argue someone out of how they feel almost always backfires. “You have so much to live for” lands as a correction. “I hear you, and I’m not going anywhere” lands as company.
- Lower the temperature. Reduce noise, turn off screens, ask other people to step out. If the person is agitated, keep your voice quiet and your movements slow. Don’t crowd them or stand over them.
- Don’t leave them alone if you’re worried about their safety, and quietly reduce access to anything that could be used for self-harm. If you can’t stay, arrange for someone else to.
- Skip the ultimatums. Threats and consequences sometimes have a place in substance use situations. In an acute psychiatric crisis, they escalate the danger and cost you the trust you need.
When to Call 988 vs. 911
This is where families get stuck, and the difference matters.
- Call or text 988 when someone is in emotional distress, expressing suicidal thoughts or in a mental health or substance use crisis that isn’t an immediate physical emergency. The 988 Suicide & Crisis Lifeline is answered at more than 200 local and regional crisis centers, and 988 supports family members, friends and caregivers calling about someone else. You don’t have to be the person in crisis to use it. Most contacts are resolved over the phone without any emergency response.
- Call 911 for an immediate physical emergency: a suicide attempt in progress, a serious injury, an overdose or violence. Say clearly that it’s a mental health emergency, and ask whether a crisis intervention trained officer or mobile crisis team is available. Many communities now dispatch behavioral health responders alongside or instead of police — worth finding out what your county has before you need it.
When Someone Refuses Help
Every state has a legal process for evaluating someone involuntarily when they appear to be a danger to themselves or others or seem unable to care for their basic needs. What it’s called, who can initiate it and how long a hold lasts vary considerably by state.
One correction worth making, because it circulates widely: Civil commitment does not require proof beyond a reasonable doubt. That’s the criminal standard. In Addington v. Texas (1979), the Supreme Court set clear and convincing evidence as the constitutional minimum — a lower bar.
In practice, families usually can’t initiate a hold alone. The path typically runs through a physician, a designated mental health professional, law enforcement or a court petition. Your county behavioral health department can tell you which applies where you live.
Involuntary evaluation is a blunt instrument and should be a last resort. It can also be lifesaving. Both are true.
Supporting Someone After the Crisis
The weeks after a crisis are when follow-through collapses. Discharge instructions get lost, the first appointment is 6 weeks out, everyone is exhausted. Practical help matters more than encouragement: making the call, driving to the appointment, tracking what was prescribed and by whom.
Ask what they actually want from you rather than assuming. Some want company, some want to be treated normally, almost nobody wants to be monitored.
And take seriously that supporting someone through a crisis takes a real toll on the person doing the supporting. If you’re the family member holding this together, our resources for families may help. Burning out doesn’t make you more useful to them.
When a Mental Health Crisis Involves Substances
Mental health and substance use overlap constantly. Among the 61.5 million adults who experienced a mental illness in 2024, roughly 31.5% also met the criteria for a substance use disorder, per SAMHSA’s survey data. Substance use can trigger a crisis, worsen one or be what someone reaches for to survive one.
If what you’re facing is primarily substance use rather than an acute psychiatric emergency, the approach is different — the tactics that help in a psychiatric crisis aren’t the ones that help someone accept treatment for addiction. Our intervention resources walk through a structured conversation, and our substance abuse hotline page has general information.
Mental Health Crisis Hotline
If you’re trying to figure out what comes next for someone you love, the National Rehab Hotline is available 24/7 to provide information, guidance and referrals to local treatment resources. Call 866-210-1303 — it’s free and confidential, and you don’t need the situation figured out before you call.
This line is for non-emergency information and referrals. For immediate danger, call 911. For a suicide or mental health crisis, call or text 988.
Frequently Asked Questions
- How Do I Know If It’s a Real Crisis or Just a Bad Week? The clearest signal is a change from the person’s own baseline that persists and interferes with daily functioning. Any mention of suicide or self-harm should be treated as urgent, however it’s phrased and however calm the person seems.
- Will Calling 988 Get My Loved One Taken Away? In most cases, no. The large majority of 988 contacts are resolved on the phone with support and referrals. You can also call 988 yourself, as a family member, to talk through the situation before deciding what to do.
- What If They Get Angry at Me for Bringing It Up? Anger is common and usually isn’t about you — it’s about being seen at a moment when someone feels exposed. Stay calm, don’t argue, don’t withdraw the offer. People often come back to the conversation days later.
- Can I Force Someone Into Treatment? Not directly, in most circumstances. Every state has an involuntary evaluation process, but families generally can’t initiate it alone — it typically requires a physician, designated mental health professional, law enforcement or a court. Criteria vary significantly by state.
- What Does It Cost to Call the National Rehab Hotline? Nothing. Calls to 866-210-1303 are free and confidential, 24 hours a day, 365 days a year. You don’t need insurance, and you can call about someone else without giving their name.
- What If I Don’t Know What to Ask For? That’s the most common reason people call. You don’t need a plan or the right vocabulary. Describing what you’re seeing is enough to get connected with support and treatment options in your area.
You don’t have to sort this out alone, and you don’t have to wait until it gets worse. If someone is in crisis, call or text 988. When you’re ready to talk through next steps, call the National Rehab Hotline at 866-210-1303 — 24 hours a day, 7 days a week, 365 days a year.