Comprehensive guide to mental health first aid including recognizing psychiatric crises (suicide, psychosis, panic, overdose), the ALGEE action plan, suicide prevention strategies, de-escalation techniques, referral guidelines, and community mental health resources.
This content is for informational purposes only. Always consult a healthcare professional.
Recognizing Psychiatric Crises
Mental health first aid (MHFA) is the help provided to a person developing a mental health problem or experiencing a mental health crisis. The approach parallels medical first aid: provide immediate support until appropriate professional treatment is received or the crisis resolves.
Suicide Warning Signs
Suicide is a leading cause of death worldwide. Early recognition of warning signs is critical for prevention.
Warning Sign
Description
Clinical Significance
Verbal threats
“I want to die,” “I wish I were dead,” “They’d be better off without me”
Direct communication of suicidal intent; requires immediate assessment
Seeking means
Obtaining a firearm, stockpiling pills, visiting bridges/ledges
High imminent risk; emergency intervention needed
Preoccupation with death
Talking/writing about death; saying goodbye; giving away possessions
Indicative of planning; advance preparation
Hopelessness
Expressing no reason to live; belief that the situation is unchangeable
Stronger predictor of eventual suicide than depression severity
Withdrawal from loved ones
Social isolation; ending participation in meaningful activities
Loss of protective social connections
Sudden calm after depression
Apparent peace after a period of severe distress
May indicate decision to complete suicide has been made
Increased substance use
Escalation of alcohol or drug consumption
Disinhibition increases capacity to act on suicidal thoughts
Flat affect, alogia (poverty of speech), avolition (lack of motivation), asociality
Recognizing a Panic Attack
Panic attacks involve a discrete period of intense fear or discomfort that peaks within minutes. The DSM-5 lists 13 symptoms; the presence of 4 or more constitutes a panic attack.
Category
Symptoms
Physical
Palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills or hot flashes, paresthesias (numbness/tingling)
Cognitive
Feelings of unreality (derealization) or detachment from self (depersonalization)
Behavioral
Fear of losing control, “going crazy,” or dying; strong urge to escape
Call 911 or poison control (1-800-222-1222); activated charcoal if early
The ALGEE Action Plan
ALGEE is the core framework of Mental Health First Aid. It is a non-linear, flexible five-step approach.
Letter
Step
Description
A
Assess for risk of suicide or harm
Evaluate immediate safety; ask directly about suicide; call 988 or 911 if imminent risk
L
Listen nonjudgmentally
Use open body language; reflective listening; validate feelings without agreeing with distortions
G
Give reassurance and information
Normalize seeking help; provide info about mental health conditions and recovery; express hope
E
Encourage appropriate professional help
Guide toward primary care, therapy, psychiatry, or crisis services; offer to help with logistics
E
Encourage self-help and other support strategies
Recommend self-care, peer support groups, exercise, sleep hygiene, spiritual/cultural resources
Applying ALGEE: Scenario Examples
Scenario
A (Assess)
L (Listen)
G (Give Info)
First E (Encourage Help)
Second E (Self-Help)
Person expresses hopelessness
Ask directly: “Are you having thoughts of suicide?”
Reflect: “It sounds like you are in a lot of pain”
“Depression is a treatable condition”
“I can help you call your doctor or 988”
“Going for a walk together might help”
Person appears paranoid
Assess safety; maintain distance if agitated
“It sounds frightening to feel watched”
“These experiences are symptoms that can improve with treatment”
“A psychiatrist can help figure out what’s happening”
“Grounding exercises like naming 5 things you see”
Panic attack
Rule out medical emergency (chest pain, SOB)
“You are safe; this will pass”
“Panic attacks are not dangerous, just uncomfortable”
“Your primary care doctor can rule out medical causes”
“Breathe in for 4 counts, hold 4, out 4; name 5 objects”
The DOs and DON’Ts of Crisis Response
DO
DON’T
Stay calm and speak in a calm, clear voice
Do not argue with delusions or hallucinations
Ask directly about suicide
Do not use “commit” suicide (stigmatizing; use “die by suicide”)
Validate their emotional experience
Do not minimize: “just snap out of it,” “others have it worse”
Maintain a safe distance
Do not block exits or crowd the person
Offer concrete options
Do not leave the person alone if they are at acute suicide risk
Call 988 or 911 when in doubt
Do not promise to keep secrets that involve safety concerns
Suicide Prevention
Suicide is preventable. The majority of people who die by suicide have contact with a healthcare provider in the year before their death, representing an opportunity for intervention.
Means Safety
Restricting access to lethal means is one of the most effective suicide prevention strategies.
Means
Safety Strategy
Evidence
Firearms
Store unloaded and locked; separate ammunition; remove from home temporarily
States with safe storage laws have lower youth suicide rates
Medications
Keep only small quantities; use blister packs; designate a medication manager
Remove knives, razors, blades from accessible areas
Common sense safety measure
High places/ bridges
Physical barriers on bridges; supervision on heights
Barrier installation reduces jump suicides without displacement
Safety Planning
A safety plan is a prioritized, written list of coping strategies and support resources for use during a suicidal crisis. It is distinct from a no-suicide contract (which is not evidence-based).
Step
Content
Examples
1
Warning signs
“I isolate myself,” “I stop eating,” “I think about death”
2
Internal coping strategies
“Deep breathing,” “listen to music,” “pet my dog”
3
People and social settings that provide distraction
“Call my sister,” “go to the coffee shop,” “walk in the park”
4
People I can ask for help
“Friend Tom (555-1234),” “therapist Dr. Smith (555-5678)”
5
Professionals or agencies
“988 Suicide and Crisis Lifeline,” “my psychiatrist (555-9012)”
6
Making the environment safe
“Give partner my medications,” “remove firearms from home”
Crisis Lines and Resources
Resource
Number
Description
988 Suicide and Crisis Lifeline
988 (call or text)
24/7/365; connects to trained crisis counselors; also serves Spanish speakers and LGBTQ+ youth via sub-lines
Crisis Text Line
Text HOME to 741741
24/7 crisis support via SMS; also available via WhatsApp
SAMHSA National Helpline
1-800-662-HELP (4357)
24/7; referrals for mental health and substance use treatment
National Helpline (Spanish)
1-800-662-9832
Spanish-language service of SAMHSA
Disaster Distress Helpline
1-800-985-5990
For emotional distress related to natural or human-caused disasters
National Poison Control
1-800-222-1222
Overdose management guidance
Veterans Crisis Line
988 then Press 1
Specialized service for veterans, service members, and their families
Evidence-Based Suicide Prevention Interventions
Intervention
Description
Evidence
Safety planning intervention (SPI)
Brief, personalized plan developed with clinician
Reduces suicidal behavior by ~50% in high-risk populations
Cognitive-behavioral therapy for suicide prevention (CBT-SP)
Targets suicide-specific thoughts and behaviors
Strong evidence for reduced suicide attempts
Dialectical behavior therapy (DBT)
Comprehensive treatment for emotion dysregulation
Best evidence for reducing self-harm and suicide attempts in BPD
Collaborative assessment and management of suicidality (CAMS)
Therapeutic framework that targets suicide-specific drivers
Reduces suicidal ideation; mixed evidence for attempts
Caring contacts
Follow-up letters or texts after hospitalization
Reduces suicide deaths in high-risk populations
De-escalation Techniques
De-escalation is the use of verbal and non-verbal communication to reduce agitation and prevent violence.
The Breathing and Posture Triangle
Element
Technique
Rationale
Body position
Stand at an angle (45 degrees), not directly facing; hands visible; same eye level
Less threatening; allows disengagement
Voice
Low, slow, calm tone; do not match their volume
Calming; models self-regulation
Personal space
Maintain 3–6 feet distance; do not block exits
Safety; reduces perception of entrapment
Verbal De-escalation Steps
Step
Example Language
1. Identify yourself and your role
“My name is ___. I am here to help you.”
2. State your intent clearly
“I want to make sure you are safe.”
3. Ask open-ended questions
“Can you tell me what is happening right now?”
4. Validate feelings
“I can see you are scared/angry. That makes sense given what you described.”
5. Set clear, simple boundaries
“I need you to sit down so we can talk safely.”
6. Offer choices
“Would you rather sit here or in the other room?”
7. Give space and time
“Take your time. I am not going anywhere.”
What to Avoid in De-escalation
Avoid
Why
Arguing or challenging delusions
Increases distress; person will defend their reality
Overcrowding (too many people in the room)
Feels like an ambush; increases paranoia
Sudden movements or loud noises
Startle response can trigger aggression
Using “calm down” or “relax”
Invalidating; rarely works
Making promises you cannot keep
Destroys trust; escalates when promises are broken
Touching the person without permission
May be perceived as aggressive; worst in PTSD or psychosis
When to Refer: Levels of Urgency
Urgency Level
Description
Examples
Action
Emergency
Immediate danger to self or others
Active suicide attempt, violent aggression, overdose, severe intoxication
Call 911; stay with person; remove means if possible
Urgent
Significant distress; risk present but not imminent
Suicidal ideation without plan; acute psychosis; panic attack not resolving
Escort to emergency department; call 988 for guidance
Semi-urgent
Moderate functional impairment; active symptoms
Depressive episode interfering with work; GAD with impairment; moderate substance use
Schedule with PCP or therapist within 1 week
Non-urgent
Mild symptoms; general mental health concern
Adjustment difficulties, mild anxiety, routine support
Encourage regular therapy; provide resource information
NAMI Resources
The National Alliance on Mental Illness (NAMI) is the largest grassroots mental health organization in the United States, providing education, support, and advocacy.