Hesperian Health Guides
Calming and de-escalating a situation
HealthWiki > Promoting Community Mental Health > Chapter 4: People in crisis > Calming and de-escalating a situation
A difficult situation can quickly change for the worse, but skillful and compassionate support can avoid a crisis.
Careful interaction can calm a tense situation. While remaining conscious of your own safety (see “Your safety matters”):
Note what is happening with the other person, especially if there are signs of serious stress like a raised voice, clenched fist, or confusion. This may be when you realize a calm situation could get worse, leading you to take more safety measures or deciding to involve someone with more experience.
Do your best to control your own physical responses:
- Concentrate on sounding calm and not raising your voice.
- Do not touch the person without their permission and avoid towering over them.
- Keep space between you. If you move, do so slowly.
- Keep your stance relaxed and your expressions as neutral as possible.
Listen carefully, show concern, and offer options as you communicate with someone in crisis).
How to communicate with someone in crisis
Your interactions with a person experiencing a mental health crisis can calm the emergency or make it more intense. A central goal of crisis communication is to be as natural and present as possible for the person in crisis. People often respond positively to confidence, calmness, and comfort. Stay aware of your safety and control your body language and tone of voice.
- Accept what the person says about their feelings or what they see. Do not downplay or deny what is real for them. For example, do not say: “It isn’t so bad,” or insist: “You are safe,” to someone yelling they are in danger from something you can’t see (see the example I only wanted to help…).
- Point out things they are doing in their body to show you are paying attention to them and their feelings: “I notice you are breathing hard.” “Your hands are shaking.” “You seem to be sweating a lot.”
- Affirm the person by showing your concern. Recognize what they are feeling: “I hear you—you feel very afraid.”
- Ask if there is something or someone that could help them now or has helped in the past. Affirm any practical ideas they mention and help them achieve them if you can (give food or water, call someone they want to talk to, or get other things they may want).
- Helping people in crisis feel a sense of power and be able to make choices is important. Even small decisions can feel like reclaiming a bit of control over their lives: ask if they would like water or tea, or if they want to sit or stand.
- If they identify specific things contributing to the crisis, offer concrete actions that might help. For example, if they say: “I am going to lose custody of my child,” you might say, “There are resources to help parents and children stay together. We can make a phone call together now if you are OK with that.”
- Do not try to control them unnecessarily. Do not make them sit down if they want to pace, do not make them talk if they want to stay silent.
- Encourage conversation and communication, but do not force any topics. Say: “We can talk about that later, if you want.”
- Do not use guilt or threats.
- Do not make promises you cannot keep, such as you will keep secret any ideas they express about hurting themselves or others.
These skills can be practiced in advance by using role plays to imagine and act
out different situations.
Every crisis is different
The way you respond to and support someone experiencing a mental health crisis depends on the circumstances. But in every case, stay aware of your safety and consider getting help, especially from those skilled in de-escalating crises and avoiding the police.
If someone is putting themselves or others in danger with their actions, for example: driving while intoxicated, acting violently at a peaceful protest, or throwing objects where there are other people:
- Ask them to slow down or suggest a different course.
- Act to prevent the danger, for example: find an alternate driver who is sober, help other protesters re-route around them, move others out of the room.
If someone seems out of touch with reality and physically unsafe:
- Ask if there is any way you can help them.
- Act to make the environment around them safer by removing objects that could hurt them.
- Tell them you are worried about their health and safety, and ask if you can connect them with someone who can help get what they need to be healthy and safe right now. (Also see “How to communicate with a person experiencing psychosis”.)
If someone says or shows they are going to physically harm you:
- Get out of the way as much as possible, creating a safe distance between you or perhaps removing yourself entirely.
- If it seems safe, say: “Let’s keep talking about this. We can figure this out without anybody getting hurt.”
- If they back off from threatening physical harm, follow the guidance about “How to communicate with someone in crisis”. If someone says or shows they are going to physically harm someone else:
- It may be easier and safer for you to remove other people from the situation than to try to move the person in crisis.
- Follow the guidance about “How to communicate with someone in crisis”.
- If it seems safe, say: “Let’s keep talking about this. We can figure this out without anybody getting hurt.”
- You might say: “I’m worried things will get worse if you hurt them. Let’s find a way to make things better instead.
- Help them make a plan to stay away from the person they want to hurt, perhaps by staying in the presence of another person who could be a calming influence.
- If you know the person they are threatening to hurt, consider letting the person know what is happening or reaching out to another person who can help.
- Consider getting help, especially from those skillful at de-escalating crises and avoiding the police.
If someone says they are considering suicide, or you suspect they are:
- Take them seriously.
- Ask directly, for example, “Are you having thoughts of ending your life?” or “Are you thinking about killing yourself?” or “Are you considering suicide?”
- Show concern but not alarm.
- Be aware that people in crisis may feel ambivalent about suicide. Focus your words to support the part of the person that wants to live, while not ignoring or downplaying the part of them that wants to die.
- Suicide crises are often time-limited. Your goal is to get the person the immediate help they need to get through the crisis and make it to a different state where they can get longer-term help.
- Be collaborative and honest. Say, for example, “I think it is important for you to connect with someone at the clinic about how you are feeling and what might help. Would you be willing to ride over there with me?”
- Although it is important to remain calm and present, rather than convey fear or alarm, you do not have to help the person all by yourself. Talk with them for a while about what they are experiencing, and then say: “I am worried about your safety, and I feel it is important for others who care about you to know you are feeling this way. Can we call your sister to help us think this through?” Or “I am worried about your safety and I would like us to call a hotline together so someone with more experience can help us think it through.”
After a crisis
Whether the crisis was resolved successfully or not, it will have an effect on you Make sure to talk about what happened with someone you feel comfortable with so you get support for the impact the crisis had on you Also, talk with others about anything you or others could do to help the person or people involved as a follow-up now that the crisis has passed Discuss with others how the root causes of the crisis might be addressed to prevent similar situations from occurring in the future and how to advocate for the changes needed.