Something isn’t right with your loved one. Perhaps your depressed wife is more withdrawn or your son quit playing tennis — something he loves doing. Are these signs their depression is in a downward spiral?
It’s possible. Caregivers need to pick up on changes in tone or behavior, be able to assess if there’s an impending emergency, and know who to call for help.
It’s important to have a plan in place long before a potential depression crisis.
“When we have a clear understanding of the warning signs and symptoms of a crisis and a clear plan of what to do, we can move with it with clarity and confidence,” says Danielle Hatchell, a licensed clinical professional counselor in private practice in Maryland.
How a Crisis Can Look in Depression
“Past behavior is one of the best ways to predict future major depression occurrences. If your loved one has been in a crisis before, looking back, what were some of the signs and signals it was about to happen?” says Dena DiNardo, a clinical psychologist and marriage and family counselor with a virtual private practice based in Philadelphia.
Your loved one may:
- Be more irritable or angry
- Be more emotional than usual
- Sleep too much or not enough
- Talk about being a “burden”
- Feel like nothing will change — that they are trapped
- Start giving away or selling important belongings
- Miss work or other important responsibilities
“If someone has stopped taking medication, started using or abusing substances, or is engaging in any sort of reckless endangerment of self or others — it can be a sign things are getting serious,” DiNardo says.
Assessing the Urgency
Talk to your loved one about your concerns. Perhaps start with what you’ve noticed, “I’ve noticed that you are sleeping a lot lately and you’ve called out of work two times this week. What’s going on?”
But DiNardo says, “If your loved one is in crisis, it can be difficult to manage if they don’t notice what you notice, so be careful not to push your observations on them.” Saying something such as “I am noticing this, which may or may not be how you are experiencing this moment” can go a long way vs. “You’re doing X or you’re not doing Y.”
If you suspect they are in crisis, ask if they are thinking about hurting themselves or someone else. Asking does not raise the risk that it will happen.
“Do they mention plans, time frames, or methods for ending their life? If the answer is yes, then there is a greater level of urgency,” says Janee Young, clinical director, Wellness Detox of LA (Los Angeles).
What To Do in the Moment
Remain calm and use a soothing tone of voice when you speak with your loved one. Take these steps:
- Do not leave this person alone unless it’s not safe to stay.
- Remove guns, pills, or anything else that could pose a threat.
- Look for signs your loved one could become violent: clenched fists, angry staring, blood vessels popping out in their forehead, etc.
- Respond to the specific situation or behavior. If the person is agitated, for instance, try deep breathing techniques to calm them down.
- Use simple language. People in crisis can get overwhelmed with a lot of words.
- Try to let other family members or friends know what’s going on.
Whom to Call for Help
911. If you think your loved one is in immediate danger of hurting themself or others or may cause significant property destruction, you need to call the police. Tell the operator it’s a mental health emergency and you need officers with crisis intervention training to respond.
988. This is the free national suicide and crisis lifeline in the U.S. It operates 24/7/365. The group also has a chat feature on its website. The lifeline is staffed with counselors who may be able to tell you how to handle the situation and/or talk to your loved one.
A mental health counselor. If your loved one has a therapist, psychologist, or psychiatrist, call them if you don’t think there’s imminent danger. If they don’t answer, you could reach out to emergency psychiatric hospitals for help. A mental health professional can tell you whether an urgent appointment is needed or if you should take them to the emergency room.
De-Escalation Techniques
You need to try to turn down the heat. Try de-escalation techniques like these:
- Move to a quiet space to minimize distractions.
- Give them some physical space so they don’t feel trapped.
- Use nonjudgmental, compassionate language. Use phrases such as:
“I am here for you and you are not alone.”
“We’re getting help to get you through this.”
- Don’t downplay their emotions. Avoid saying things such as:
“Other people have it worse.”
“You’re making a big deal out of nothing. Just calm down!”
- Don’t promise to keep the episode a secret. Stress that you are trying to help them feel better.
Your Go-To Crisis Plan
Consider putting together a written plan to use in case there’s an emergency. The time to do it is when your loved one is thinking clearly and is stable.
It should include:
- Mental health diagnosis
- Medications
- Any alcohol or drugs that may have been used
- Hospitalizations
- Previous suicide attempts (if any)
- Names and phone numbers of mental health professionals and how to get a hold of them outside of office hours
- A plan on when to call 911 (threatening suicide or harm to others or significant damage to property)
- A plan for what to do/who to call during a lesser but serious crisis
- List of past triggers and warning signs and what helped diffuse a crisis in the past
- Names of preferred hospitals or treatment centers
- Names of other caregivers
Some states recognize a legal document called a psychiatric advance directive. It lists your loved one’s mental health care preferences and allows you to name a health care proxy in case they are unable to speak for themselves.
Check the National Resource Center’s psychiatric advance directives website for more information.
Taking Care of the Caregiver
You can’t take care of your loved one if you neglect yourself. Burnout is common among caregivers. To prevent it, protect your physical and mental health:
Sleep well. Aim for seven to nine hours a night.
Get moving. Exercise promotes stress-relieving hormones. Try to do something physical every day. Walk the dog, take an exercise class, or swim some laps. Do whatever activity you enjoy.
Eat well. Stick to unprocessed foods such as whole grains, fresh fruits and vegetables, and lean proteins.
Avoid drugs and alcohol. They tend to add to stress rather than relieve it.
Take a break. Don’t feel guilty about taking time for yourself. Make a standing lunch date or outing with friends to recharge your batteries.
DiNardo says, “Often, it’s not the first time a loved one is going through something like this, so for the caregiver, how’d you get through it last time? Who supported you, and how? How soon can you reach out for support, even if it’s to let someone know what’s going on, so that mentally you are not alone?”
Caregiver Resources
The National Alliance on Mental Illness (NAMI) runs a family caregiver helpline.
- 1-800-950-NAMI (6264) press 4
- Text FAMILY to 62640
NAMI sponsors virtual and in person support groups for families. You can search for one by state on their website.
