Mental Health First Aid in Crisis Situations

Preparation
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Mental Health First Aid in Crisis Situations

Difficulty: Beginner to Intermediate
Time to Complete: 30 minutes to read, 4–8 weeks of practice to build proficiency

Overview

When disaster strikes or life falls apart, the injuries we can’t see often outlast the ones we can. Mental Health First Aid (MHFA) is the equivalent of CPR for a psychological crisis — a set of evidence-based actions you can take to support someone experiencing acute emotional distress until professional help is available or the crisis resolves. This guide teaches you how to recognise, respond to, and sustain support for people in mental health emergencies when the grid is down, professionals are unreachable, or you’re simply the only person there who cares enough to act.

Why This Matters

Suicide is the second leading cause of death for people aged 15–34 globally. In crisis situations — natural disasters, civil unrest, economic collapse, or personal trauma — mental health episodes spike dramatically. Research after Hurricane Katrina showed that rates of serious mental illness doubled in affected populations. After the 2020 lockdowns worldwide, anxiety and depression rates surged by 25–40%.

You don’t need a psychology degree to help someone through a crisis. You need a framework, some basic skills, and the willingness to act.

What Mental Health First Aid Is (And Isn’t)

:white_check_mark: What MHFA Is :cross_mark: What MHFA Is Not
An initial response to a mental health crisis A substitute for therapy or medication
Using active listening and empathy Trying to “fix” someone’s problems
Assessing risk of self-harm or harm to others Diagnosing a mental illness
Connecting someone to resources Forcing someone to accept help
Providing ongoing emotional support Replacing peer support groups long-term
Staying calm and non-judgmental Taking on someone else’s trauma as your own

The ALGEE Action Plan

The internationally recognised framework for Mental Health First Aid is ALGEE. Memorise it. Practice it. It works.

A — Approach, Assess for Risk of Suicide or Harm

Approach the person. Not aggressively. Not with a diagnosis. With calm human presence.

  • Choose a quiet, private space if possible
  • Speak slowly and clearly
  • Use their name
  • Make eye contact (but don’t stare)
  • Keep your body language open — uncrossed arms, relaxed shoulders
  • Check for immediate physical danger (are they injured? Is there a weapon? Are they in an unsafe location?)

Assess for risk. This is the hardest part and the most important. You’re looking for:

  • Suicidal ideation: Direct or indirect statements about wanting to die, being a burden, or having no reason to live
  • Self-harm indicators: Fresh cuts, burns, unexplained injuries
  • Risk to others: Threats, plans, access to weapons, escalating aggression
  • Inability to care for self: Not eating, not drinking, not sleeping for extended periods, complete withdrawal

:warning: Critical Warning: If someone is in immediate danger of harming themselves or others, your job is to keep them safe — not to counsel them. Remove access to means of harm, stay with them, and get professional help if available.

L — Listen Non-Judgmentally

This is where most people fail. They listen to respond, not to understand. Here’s how to actually listen:

Do:

  • Let them talk without interrupting
  • Reflect back what you hear: “It sounds like you’re feeling completely overwhelmed right now”
  • Validate their emotions: “That sounds incredibly difficult. Your feelings make sense.”
  • Ask open questions: “Can you tell me more about what’s been going on?”
  • Sit with silence. Not every gap needs filling.
  • Accept what they’re saying without agreeing or disagreeing — just receive it

Don’t:

  • Interrupt with your own stories (“I know exactly how you feel — when I…”)
  • Minimise their experience (“It’s not that bad,” “Other people have it worse”)
  • Offer unsolicited advice (“Have you tried exercising?”)
  • Judge or moralise (“You shouldn’t feel that way,” “You have so much to be grateful for”)
  • Use toxic positivity (“Everything happens for a reason”)

G — Give Reassurance and Information

People in crisis often feel:

  • Alone (“Nobody understands”)
  • Hopeless (“This will never end”)
  • Broken (“There’s something wrong with me”)
  • Powerless (“I can’t control anything”)

Your reassurance should address these feelings with truth, not platitudes:

What They Feel What NOT to Say What TO Say
“I’m broken” “You’re fine” “What you’re experiencing is a normal response to an abnormal situation. Your brain and body are trying to protect you.”
“Nothing will get better” “It’ll be fine” “I can’t promise what tomorrow holds, but I can tell you that feelings this intense don’t last forever. They will change.”
“I’m alone” “You have me” (alone) “You’re not alone. I’m here with you. And there are others who want to help too.”
“I have no control” “Just take control” “You can’t control what happened. But right now, in this moment, you have some choices — even if they’re small ones.”

E — Encourage Appropriate Professional Help

In a normal context, this means connecting someone with a therapist, GP, crisis hotline, or psychiatric service. In a grid-down or disaster scenario, professional help may not be immediately available. Here’s how to adapt:

Normal conditions:

  • Provide crisis hotline numbers (save them now — see Quick Reference section below)
  • Help them make an appointment
  • Offer to accompany them to their first visit
  • Research low-cost or free mental health resources in your area

When professionals are unavailable:

  • Connect with the most mentally stable, experienced person in your community
  • Establish a peer support rotation — regular check-ins among community members
  • Use structured peer support techniques (see Section 6)
  • Maintain routines and purposeful activity — idleness is the enemy of mental health in crisis
  • Create space for grief, processing, and emotional release — these are not luxury activities; they’re survival activities

E — Encourage Self-Help and Other Support Strategies

The research is clear: certain activities measurably improve mental health outcomes. Encourage these:

Immediate (can do right now):

  • Deep breathing: 4 seconds in, hold 4, out 6 — activates the parasympathetic nervous system
  • Grounding technique (5-4-3-2-1): Name 5 things you see, 4 you feel, 3 you hear, 2 you smell, 1 you taste
  • Physical movement: Even 5 minutes of walking changes neurochemistry
  • Drink water and eat something — dehydration and hunger amplify anxiety dramatically

Short-term (daily habits):

  • Sleep hygiene: Consistent times, dark room, no screens before bed (if power exists)
  • Physical exercise: 20–30 minutes daily reduces cortisol and increases endorphins
  • Social connection: Even brief, purposeful contact with another human
  • Purposeful activity: Chores, tasks, contributions — the brain needs to feel useful
  • Journaling: Externalising thoughts reduces their intensity
  • Nature exposure: Even 10 minutes outside reduces stress markers measurably

Long-term (ongoing resilience):

  • Learn a practical skill — competence builds confidence
  • Build and maintain community connections
  • Practice gratitude deliberately (documented to increase wellbeing by 25%+)
  • Meditation or mindfulness (reduces relapse in depression by 34%)
  • Limit news/social media consumption in crisis — stay informed, not inundated

Recognising Specific Crisis Signs

Different mental health emergencies present differently. Knowing the signs helps you respond appropriately.

Panic Attack

Signs:

  • Sudden intense fear peaking within minutes
  • Rapid heartbeat, trembling, sweating
  • Feeling of choking or inability to breathe
  • Chest pain (often mistaken for heart attack)
  • Sense of unreality or detachment
  • Fear of dying or losing control

What to do:

  1. Stay calm — your calm is contagious
  2. Speak slowly: “You’re having a panic attack. It feels terrible but it’s not dangerous. It will pass.”
  3. Guide their breathing: “Breathe with me. In for 4, out for 6.”
  4. Ground them: “Can you feel your feet on the ground? Press down. Now name 3 things you can see.”
  5. Don’t dismiss it and don’t dramatise it
  6. Stay with them until it passes (usually 5–20 minutes)

Severe Depressive Episode

Signs:

  • Persistent hopelessness lasting 2+ weeks
  • Inability to feel pleasure (anhedonia)
  • Significant changes in sleep or appetite
  • Loss of energy, psychomotor slowing or agitation
  • Difficulty concentrating or making decisions
  • Thoughts of death or suicide

What to do:

  1. Approach gently — depression makes social interaction exhausting
  2. Don’t try to cheer them up — validate instead
  3. Encourage small, manageable tasks: “Can we just sit outside for 5 minutes?”
  4. Watch closely for suicide risk — the highest risk point can be when someone starts to recover (they may have energy to act on thoughts they couldn’t before)
  5. Maintain regular contact — check in even when they don’t reciprocate
  6. Watch for the warning sign of sudden improvement after severe depression — this can indicate they’ve made a decision to end their life and feel relief about it

Acute Stress Response / PTSD Trigger

Signs:

  • Flashbacks (reliving the traumatic event)
  • Emotional numbing or dissociation
  • Hypervigilance (constantly scanning for threats)
  • Startle response to loud noises or sudden movements
  • Avoidance of reminders
  • Aggression or irritability
  • Nightmares

What to do:

  1. If they’re dissociating or flashbacking, gently bring them to the present: “You’re safe. You’re here with me now. It’s 2026. Can you feel the ground?”
  2. Don’t touch them without permission — touch can escalate a trauma response
  3. Let them talk about the trigger if they want to, don’t push
  4. Help them regulate breathing
  5. Maintain predictable routines — trauma disrupts the sense of safety that predictability provides
  6. If you’re in a grid-down scenario, minimise sudden loud noises when possible and communicate before approaching people from behind

Psychotic Episode

Signs:

  • Hallucinations (seeing, hearing, or feeling things that aren’t there)
  • Delusions (fixed false beliefs resistant to contradiction)
  • Disorganised speech — jumping between unrelated topics
  • Inappropriate emotional responses
  • Extreme withdrawal or agitation
  • Difficulty distinguishing reality from imagination

What to do:

  1. Do not argue about their reality. If they say they see something, don’t say “it’s not there.” Say “I believe that you see that. I don’t see it myself, but I believe you.”
  2. Reduce stimulation — quiet room, few people, low light
  3. Speak simply and calmly
  4. Don’t play along with delusions but don’t aggressively contradict them either
  5. Assess for danger — psychosis can sometimes lead to unpredictable behaviour
  6. This is the most challenging mental health emergency to handle without professional help. Document the symptoms, maintain safety, and seek help whenever possible

Peer Support Techniques for Long-Term Crisis Scenarios

When you’re looking at weeks, months, or longer without access to professional mental health services, your community becomes the mental health infrastructure. Here’s how to build it.

Active Listening Circles

A structured group activity that builds connection and provides emotional release:

  1. Gather 4–8 people in a circle
  2. Set ground rules: confidentiality, no interrupting, no advice-giving, no judgment
  3. One person speaks for a set time (3–5 minutes)
  4. Others listen only — no reactions, no comments
  5. After time is up, each listener shares one sentence: “What I heard you say was…”
  6. Move to the next person
  7. Close with a grounding moment together

This isn’t therapy. It’s structured witnessing. It’s powerful.

Buddy System for Mental Health

In any crisis scenario, pair people up for regular check-ins:

  • Meet once or twice daily — 10 minutes minimum
  • Each person takes turns sharing how they feel (use a 1–10 scale for quick check-ins)
  • Report concerns to leadership if someone drops below 3 consistently
  • Rotate buddies periodically to prevent burnout
  • Buddies have permission to check in if they haven’t seen their person — this is a safety feature, not surveillance

Community Rituals

Humans are ritual creatures. In crisis, ritual restores meaning and structure:

  • Shared meals with a moment of reflection or gratitude
  • Evening gatherings — stories, music, shared activities
  • Marking losses — grief rituals are essential after deaths, even non-violent ones
  • Celebrating small wins — survived another week, built a shelter, helped someone
  • Regular meetings to discuss community concerns openly

Caring for Yourself (The Oxygen Mask Rule)

You cannot pour from an empty cup. In prolonged crisis, caregiver burnout is one of the most common and dangerous risks. Signs include:

  • Emotional numbness or detachment
  • Irritability with the people you’re helping
  • Physical exhaustion that doesn’t improve with rest
  • Cynicism or loss of hope
  • Neglecting your own basic needs
  • Using substances to cope more frequently

Prevention strategy:

  • Take shifts with other helpers — never be the sole mental health support person
  • Set boundaries — it’s okay to say “I need 30 minutes” and step away
  • Process your own experiences — talk to someone, journal, cry, whatever works for you
  • Maintain at least one activity that is not crisis-related (reading, crafting, exercising)
  • Sleep. Seriously. Sleep deprivation amplifies every negative emotion by roughly 60%.

Quick Reference Checklist

Immediate Crisis Response (ALGEE)

  • A — Approach calmly, assess for immediate risk (self-harm, harm to others)
  • L — Listen without judgment, interrupt, or minimising
  • G — Give honest reassurance (no toxic positivity, no platitudes)
  • E — Encourage professional help (adapt to available resources)
  • E — Encourage self-help strategies (breathing, grounding, exercise, connection)

Panic Attack Support

  • Stay calm and present
  • Slow, clear reassurance: “This will pass”
  • Guide breathing (4-4-6 pattern)
  • Ground using 5-4-3-2-1 technique
  • Stay until it passes (typically 5–20 minutes)

Suicide Risk Assessment

  • Ask directly: “Are you thinking about ending your life?” (Direct questions reduce risk, they don’t increase it)
  • Ask if they have a plan
  • Ask if they have means (access to weapons, pills, etc.)
  • Ask about timing — immediate risk vs. general thoughts
  • If immediate risk: stay with them, remove means, get help
  • If not immediate: maintain contact, reduce isolation, connect to resources

Daily Mental Health Maintenance in Crisis

  • Regular sleep schedule
  • Physical activity (minimum 20 minutes)
  • At least one meaningful social interaction
  • Purposeful task or contribution
  • Time outside or in natural light
  • Check in with your buddy
  • Acknowledge one thing that went well today

Sources & Further Reading

Mental Health First Aid Series — Vivaed @ endscenar.io