ER for a Mental Health Crisis: When to Go and What to Do

Go to the emergency room, or call 911, when you or someone you love is in immediate danger: a plan or intent to die, an attempt in progress, violence toward others, or a state so disorganized that safety cannot be kept at home. For distress that is serious but not immediately dangerous, call or text 988 first. That line runs 24 hours a day, 7 days a week, and the counselor can help you decide whether the ER is the right next step.

Deciding quickly is hard, so this guide turns the decision into a short set of checks you can run in a few minutes, followed by what to say at the door and what usually happens next. It is educational and does not replace a clinician’s judgment.

The one paragraph to remember

When a mental health crisis involves a risk to life, call 911 or go to the nearest emergency room. When it involves intense distress without immediate danger, call or text 988, or chat at 988lifeline.org, which is open 24 hours a day, 7 days a week and is confidential. The National Institute of Mental Health’s find-help page lists both options side by side: 911 or the nearest ER for life-threatening situations, and 988 for emotional distress or suicidal thoughts.

Five checks: ER now, or call 988 first?

Run these in order. A “yes” to any of the first three means stop reading and call 911 or go in now.

Check 1, a plan or means within reach: Is the person thinking about ending their life and has a plan, a date, or access to something they would use? If yes, treat it as an emergency. Do not leave them alone, and ask a trusted person to remove access to anything dangerous while you get help.

Check 2, an attempt already underway: Has the person already taken something or hurt themselves? Call 911 right away. Medical problems come first, and poison control or paramedics can guide you while you wait.

Check 3, danger to others: Is the person threatening or moving toward hurting someone else? Call 911, put distance between people, and do not try to restrain or argue.

Check 4, loss of contact with reality: Is the person hearing or seeing things that are not there, not sleeping for days, or acting in ways that are very unlike them, and unable to stay safe or take care of basic needs? This usually warrants the ER or a call to 911, particularly if confusion came on suddenly, because a medical cause such as an infection, a reaction to a substance, or withdrawal needs to be ruled out.

Check 5, distress without immediate danger: Is the person frightened, hopeless, or overwhelmed, yet able to talk, agree to a plan, and stay with someone? Call or text 988 first. If the counselor and you agree that more help is needed tonight, go to the ER together.

Why the ER fits some crises and not others

An emergency room is designed to find and treat immediate medical danger. It is not designed to provide ongoing therapy. Knowing what it does well helps you decide:

Safety and stabilization: The team can keep a person safe in a monitored setting while the crisis settles, which is hard to arrange at home.

Medical clearance: Staff check for physical causes or contributors, such as intoxication, withdrawal, medication effects, or injury, before deciding what psychiatric care is needed.

A path to the next level of care: A clinician evaluates whether the person can safely go home with a plan, needs outpatient follow-up, or should be admitted. If you are weighing those options, our guide on how families decide between inpatient and outpatient care explains the differences.

A legal floor on screening: Under the federal law called EMTALA, Medicare-participating hospitals must provide a medical screening examination and stabilizing treatment for emergency conditions regardless of ability to pay, according to the Centers for Medicare & Medicaid Services. Worry about cost should not stop you from going when someone may be in danger.

What the ER cannot promise

It helps to arrive with realistic expectations. A visit can take many hours. Some hospitals have psychiatric clinicians on site and others rely on remote evaluation or transfer, so the evaluation may happen on a different timeline than a medical visit. If an inpatient bed is recommended, the person may wait in the ER until one opens, sometimes at another facility. None of this means the visit was a mistake. It means you should plan for a long stay and bring what makes it bearable. If a gap between the ER and the next level of care is likely, read our guide on staying safe while waiting for a treatment bed.

What to do today: write the three-line note

Before a crisis, or in the first minutes of one, write three lines on your phone or on paper. Handing this to triage staff saves the person from having to explain everything while overwhelmed.

Line 1, why we are here: One sentence in plain words, such as “She told me tonight she wants to die and has a plan” or “He has not slept in four days and is hearing voices.”

Line 2, what is in the body: Any alcohol, drugs, or medications taken in the last day, and any medical conditions, with the best times you can recall.

Line 3, who and what is helping: The names of current providers, the pharmacy, an emergency contact, and insurance details if you have them.

At the desk, say the safety concern first and say it directly. Then ask these questions: “Can we be seen by someone who does psychiatric evaluations tonight?” and “What is the plan if a bed is needed?” If you are a support person, ask what you may do while the person is being evaluated, and what information the team needs from you.

If you are not sure, call 988

Many people hesitate because they are unsure whether their situation is serious enough. That uncertainty is a reason to call, not a reason to wait. The 988 Suicide & Crisis Lifeline accepts calls, texts, and online chat, and its counselors can talk through what is happening with you. The lifeline notes that it is a confidential service. Veterans can call 988 and press 1, or text 838255, according to NIMH. For a plain overview of the service, see the Substance Abuse and Mental Health Services Administration’s 988 page.

If someone is in immediate danger, call 911. If you are supporting a person who refuses help, our guide on what to do if someone is having a mental breakdown covers steps to take in the moment, and what happens after a 5150 hold explains one example of how an involuntary evaluation works in California. The rules differ in every state, which is why our state-by-state guide to involuntary psychiatric holds is worth bookmarking before you ever need it.

After the ER: do not skip the follow-up

A crisis visit is the start of care, not the end. Before leaving, ask for the discharge instructions in writing, the names and phone numbers of follow-up providers, and the date of the first appointment. The days right after discharge can be a vulnerable time, so ask who will check in with you and when. To work out which kind of program fits, take our inpatient treatment quiz for depression or read the 10 questions to ask when choosing a treatment program. If the crisis involved alcohol or other substances, our team can talk through treatment options at 866-644-7911. We can also answer questions confidentially if you are helping a loved one.

If you or someone near you needs help finding care after a crisis, call us at 866-644-7911. We are not an emergency service. In an emergency, call 911 or 988.

Frequently asked questions

Will the ER admit me if I say I am having suicidal thoughts? Not necessarily. A clinician evaluates risk and decides, with you, whether you can go home safely with a plan, need outpatient follow-up, or should be admitted.

Should I drive someone to the ER myself? If the person is calm and agrees, driving may be fine, with a second adult in the car. If they might harm themselves or others, or may try to leave the vehicle, call 911 instead.

Is the ER the same as a crisis center? No. Some areas have crisis stabilization units or mobile crisis teams. Ask 988 what exists near you.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. It is not a substitute for care from a qualified professional. If you or someone else is in immediate danger, call 911. For emotional crisis support, call or text 988 any time.