Going to the ER for a Mental Health Crisis

Dealing with a mental health crisis is extremely challenging in not only actually dealing with the symptoms that are coming up, but also in finding the right care, treatment, and support to get you through. Ideally, there will be a plan in place in the case of dramatic symptom increase, but sometimes it's just not enough or the plan doesn't fit your needs at the time.

I recently found myself in a crisis, without a solid plan to keep myself safe and return to wellness. The lead-up to this crisis was fairly quick, and I found myself in a place where I didn't exactly know where to turn. During my winter break from school, I had reduced one of my antipsychotic medications because I was experiencing less symptoms due to less general stress. I had a plan to go back to my previous dose when my classes started picking up again, and I had an appointment with my doctor a couple of weeks before the beginning of the semester to discuss this. Unfortunately, during that appointment, my doctor informed me that she would be taking a few months leave, and I would be transferred to a new doctor. My dose was not increased at that time, and I was instructed to make the next available appointment with my new doctor.

The next available appointment was many weeks out, and I was left to start school and increase my stress without enough medication on board, and I didn't have a primary psychiatric provider. As expected, my symptoms increased dramatically, and I began experiencing frequent and aggressive command hallucinations. I struggled to ignore the voices that were telling me to harm myself, and I had a very challenging conversation with my therapist just before the weekend trying to make an emergency plan the get through the next few days. On that Friday evening, I made a call to the on-call psychiatrist who prescribed me ten days worth of an additional antipsychotic that was intended to make it to my next appointment that was, at this point, two and a half weeks away. I was told that if my symptoms were not improving the next day that my only option was to go to the emergency room. On Saturday, my symptoms had not decreased, so I made a trip to the ER that night.

I was really concerned about going to the emergency room because there was so much I didn't know about the process. I was worried they would deem me to be a threat to myself and keep me for who knows how many days. I didn't feel like I needed to be hospitalized — I was close to feeling that way, but not quite. My experience actually turned out to be relatively positive, and in case anyone reading is in a place where they are considering going to the ER for a mental health crisis, here's an account of my experience with it.

I walked up to the doors and had my vitals taken outside (this occurred during the COVID-19 pandemic) and was asked to describe my symptoms. I told the nurse that I was experiencing obtrusive command hallucinations that were instructing me to harm myself, but I did not have a plan to act on those instructions. The nurse was compassionate and directed me into the main lobby to wait to be seen. I was called back relatively quickly, and I was seen by a PA who was kind but direct. She ended up prescribing me five doses of a medication to help me sleep through the next few days while the antipsychotic built up in my system. The most challenging part of the experience was waiting in the lobby for over an hour after being seen by the PA. A nurse eventually let me wait outside because I was quite overwhelmed by the real sounds of the other people waiting as well as the not-real sounds of all the voices I was hearing. I was able to go home that night after a trip to the pharmacy to get my new medication.

My symptoms eventually decreased enough for me to function somewhat properly, and I was able to catch up on my schoolwork. It is currently the day before my appointment with the new doctor, and I am looking forward to making a long-term medication plan in order to keep me out of the emergency room in the future. I have also discussed crisis options with my therapist at more length, so I know what my options are if I'm in a situation like this agian, which I think is important. Plans help me feel more in control.