When to Go to the ER for a Mental Health Crisis: 6 Signs

Go to an emergency room now if you cannot keep yourself or someone else safe, if you have taken something that could cause harm, or if you cannot tell what is real. Call 911 or go to the nearest ER. If you are in distress but not in immediate danger, call or text 988 first; a trained counselor can help you decide on the right level of care. This guide gives you six clear signs, what usually happens once you arrive, and five questions to ask while you are there.

The short version you can act on today

Go to an emergency room for a mental health crisis when you cannot keep yourself or someone else safe for the next few hours, when you have taken something that could harm you, or when you are seeing, hearing, or believing things that are not real and cannot tell the difference. For any of these, call 911 or go to the nearest ER. The 988 Suicide and Crisis Lifeline is also available by call, text, or chat 24 hours a day, every day of the year, if you are unsure which level of help you need.

This is a decision most people face while frightened and exhausted, which is why the rule is simple: when safety is in doubt, choose the higher level of care. An ER visit that turns out to be more than you needed costs time. Waiting when you needed it can cost far more.

Six signs it is an ER-level crisis

These are the situations where emergency care is the right call. If any one of them is true, do not wait for a scheduled appointment.

• A plan or intent to self-harm: thinking about ending your life with a specific plan, a time, or access to the means is an emergency, not something to sit with overnight.
• Intent to harm someone else: urges or plans to hurt another person, especially when you feel you may act on them, call for immediate emergency help.
• Something already taken: if you have swallowed or used something in an amount that could cause harm, call 911 or poison control right away rather than waiting to see how you feel.
• Loss of contact with reality: hearing voices that give commands, seeing things others do not, or holding fearful beliefs you cannot set aside can mean you need an urgent medical and psychiatric evaluation.
• Unable to stay safe alone: if you do not trust yourself to be alone tonight and no safe person can stay with you, an ER gives you a safe place while the next step is worked out.
• Severe confusion or agitation: sudden disorientation, extreme restlessness, or behavior that is very unlike the person can come from a medical cause that needs a doctor quickly.

The National Institute of Mental Health says that in life-threatening situations people should call 911 or go to the nearest emergency room, and that 988 is the option for emotional distress and suicidal thoughts.

When 988 or a crisis line is the better first step

Not every hard night is an ER night. If you are overwhelmed, panicking, grieving, or having suicidal thoughts without a plan or immediate intent, calling or texting 988 is a good first move. Counselors can talk through what is happening, help you build a safety plan for the next few hours, and tell you honestly if they think you should be seen in person. SAMHSA describes the 988 Lifeline as free and available any time, and the NIMH suicide prevention page points to the same number for anyone struggling.

If you are in immediate danger at any point during the call, say so. The counselor can help connect you with emergency services. This site is not an emergency service, and nothing here replaces a call to 911 or 988.

When it might be a medical emergency, not only a mental health one

Several serious medical problems look like a mental health crisis, and a doctor needs to rule them out. Go to the ER, or call 911, if the distress comes with any of the following:

• Chest pain or trouble breathing: panic can cause both, but so can heart and lung problems, so they should not be assumed to be anxiety.
• Sudden confusion or a first-ever episode of unreal beliefs: new, abrupt changes in thinking can have a medical cause such as infection, injury, or a reaction to a substance.
• Heavy drinking that was stopped suddenly: shaking, seizures, severe sweating, or seeing things after stopping alcohol can signal dangerous withdrawal and need emergency care.
• A head injury or fainting: any loss of consciousness or new severe headache should be checked by a doctor.

If you are not sure whether a symptom is anxiety, our guides on the feeling of impending doom and being so anxious you cannot function explain how to tell the difference, but when a physical symptom is new or severe, see a doctor first.

What to do in the next 10 minutes

If you have decided to go, these steps make the visit safer and smoother.

1. Do not drive yourself if you are in acute distress or have taken anything. Call 911 or ask a trusted person to take you.
2. Move anything you could use to harm yourself out of reach, or ask someone to remove it, and stay in a room with another person.
3. Take a list of what you take, including over-the-counter items and supplements, plus your insurance card and the name of any current provider.
4. Write down, in two sentences, why you came in. Handing this to the triage nurse keeps the reason from getting lost in a long wait.
5. Note the time you arrive. You will want it later if you have questions about your chart or a bill.

What usually happens at the ER

Experiences differ by hospital, but the usual sequence has a few parts. A triage nurse asks why you came and checks your vital signs. A doctor or other clinician often does a medical screening first, which may include an exam and tests, to rule out physical causes. Under federal law, hospitals with emergency departments generally must screen anyone who comes in asking for care, whatever their ability to pay. After that, a mental health professional may evaluate you, either in person or by video.

The wait can be long, and the ER is not always the calmest place. Some hospitals have a dedicated psychiatric emergency area. Others keep you in a regular room until a bed or evaluator is available, and a few transfer you to another facility. Knowing this ahead of time makes the wait easier to bear.

Possible outcomes include going home with a safety plan and follow-up, admission for inpatient care, or, if a clinician decides you are a danger to yourself or others and you do not agree to stay, an involuntary hold. Rules for holds differ by state; our state-by-state guide to involuntary psychiatric holds explains how the process works. If you are worried about the aftermath, see whether a hold goes on your record and who pays for a hold.

Five questions to ask while you are there

You have a right to ask questions, even when you are in crisis. Write these down or ask someone with you to ask them:

1. Who will be evaluating me, and about how long should I expect to wait?
2. Am I here voluntarily, and what would change that?
3. If I am discharged, what is my written safety and follow-up plan?
4. If I am admitted, which facility will I go to, and can someone I trust be told where I am?
5. Who do I contact about my records or bills afterward?

If you are worried about someone else

If a person you love is in immediate danger, call 911, stay with them, and tell the dispatcher it is a mental health emergency. Speak calmly, remove obvious hazards if it is safe to do so, and avoid arguing about whether the crisis is “real.” If the danger is less immediate but you are scared, you can call or text 988 yourself to ask how to help. Our guide to getting someone psychiatric help covers the options in more depth.

After the crisis: choosing the next level of care

An ER visit is rarely the end of treatment. Before you leave, make sure you know who your first follow-up will be and when. If you are weighing a bigger step, our inpatient treatment quiz for depression and the guide to deciding between inpatient and outpatient alcohol treatment can help you think through what level of care fits. If you want help finding a program, call 866-644-7911 to talk through options. You can also reach the SAMHSA National Helpline at 1-800-662-4357, which SAMHSA describes as free, confidential, and open 24 hours a day, every day of the year, for treatment referral and information.

For help finding a program that fits your situation, you can reach us at 866-644-7911. In an emergency, call 911. For crisis support at any hour, call or text 988.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. It is not an emergency service. If you or someone else is in immediate danger, call 911 or go to the nearest emergency room. For emotional crisis support, call or text 988.