Dealing with mental crises

Mental crises are situations involving severe overload. They are usually triggered by a stressful event, such as the death of a loved one or the transition to secondary school. However, they can also occur within the scope of mental illnesses or if stress is caused by the combination of multiple minor events during everyday life.

During a crisis, it is no longer possible to use the usual strategies or skills to achieve certain life goals. The crisis often causes people to question their life so far. Crises cause many people to lose their inner balance and experience feelings of disorientation, hopelessness, sadness, confusion or panic.

People in a crisis usually look for help and new solutions. However, if the crisis persists and no solution is found to the existing problems, it can worsen. This can result in people needing professional help. In some cases, it is also possible for a mental illness to develop or reoccur.

If someone is able to avert a crisis or find a way out of it and learn something from the experience, this is referred to as mental resilience or simply resilience. This means that crises can pose health risks but also be an opportunity for personal growth.

There are various types of mental crises that have different triggers. They can be roughly divided into developmental crises, change-induced crises and traumatic crises. The triggers can lead to a crisis but do not do so with everyone. Mental crises can also occur in relation to mental illnesses.

Developmental crises are generally triggered by biological changes, such as puberty or menopause. The triggers of change-induced crises include major life events, such as finishing school, leaving a job or retiring.

If something very alarming suddenly happens, this can trigger a traumatic crisis. Examples include natural disasters or experiencing or witnessing an act of violence.

Mental crisis can particularly occur if people are confronted with a very significant, alarming event. Such events include the sudden loss of a loved one, an accident or an act of violence, for example. People typically process the crisis in several phases.

Shock phase

In the first few moments and even for several days after a particularly significant event, people find themselves in a state of shock. In this phase, they often struggle to believe that things actually happened the way they did. They experience inner chaos, fluctuating between numbed feelings and powerful emotional outbreaks. And sometimes, everything seems to work “normally” again.

Reaction phase

The initial shock is followed by the reaction phase. This generally lasts for anything between a few days and several months. Emotional outbreaks continue to alternate with numbness and strong physical symptoms. If people are unable to cope with the strong feelings, they sometimes try to numb them with alcohol, other drugs or behavior that is harmful to their health. In these cases, however, there is a risk of the crisis intensifying.

If the crisis worsens, the person affected can pose a risk to themselves or others. In this phase, the mental crisis can also develop into a mental illness.

Processing phase

Some people succeed in calming their feelings again with professional help. The crisis can be processed through psychotherapy or with the aid of medication, for example. Many people manage to process crises on their own or with the support of loved ones. In this phase, they are able to face the triggering event, deal with it and give meaning to what happened. People in crisis now typically begin to accept the events.

Reorientation phase

In the reorientation phase, the pain of what happened can be accepted and let go of. In this phase, people often realize that they have had fewer connections with others during their crisis. The desire to connect with people returns. Relationships often even take on a deeper quality. New values and behaviors can be created. Some people are also able to extract something meaningful from the events and therefore take away something positive from what happened.

Something new is needed to overcome crises. After all, a crisis means that you cannot continue as before. What people can need in a crisis are new or rediscovered attitudes, views, thoughts or behaviors. Some behaviors and thoughts can generally increase resilience:

Connecting with people you trust

It is rare for people to be able to find their way to the new attitudes, thoughts or behaviors they need on their own. For most people, talking to others helps when dealing with crises. Speaking to people you trust about the difficulties you experience can make the actual problem clearer. Putting your heads together to think about things can also help you find a solution. Finding that other people can be there to provide support in a crisis can boost mental strength.

Use sense or goals as a guide during mental crises

Finding new solutions and directions in a crisis usually takes a great deal of strength. Neurologist and psychiatrist Viktor Frankl once said: “Those who have a why, can bear almost any how”. In relation to mental crises, this means that it can help to remember why the effort is worthwhile.

Some people may be helped by the thought of keeping going for the sake of their children. Believers may think of God. Others imagine something they want to achieve in the future. The things that motivate people and give them focus differ greatly.

Reduce stress and tension

In addition, everything helps that lowers the stress and tension levels of people in a crisis, provides a sense of security and reduces strain. If the crisis is not yet too severe and the tension is not too intense, this can even include practices like meditation or relaxation techniques. However, caution should be exercised with regard to these methods: as they are often associated with increased inner awareness, they can further heighten tension in acute crises.

Healthy eating, plenty of sleep, exercise and sport can also help.

As someone close to the person affected, it can be useful to offer them the chance to talk or to support them in other ways. People can sometimes overcome a crisis with the support of those around them. It helps for relatives and close friends to offer their support as early as possible.

In some people, the crisis worsens and leads to a mental breakdown or emergency. If people in crisis express plans or thoughts of being tired of life, those close to them should take action. The people in crisis may be in a disoriented state in which they could endanger themselves or others. At this point, it is best to seek professional help immediately.

For people who want to learn how to deal with mental crises and illnesses from others, there is now the concept of “mental health first aid”, i.e. special courses on mental health. These courses have transferred the concept of first aid for physical conditions to first aid for mental illnesses and crises. The first aid course can improve understanding of mental health and reduce stigmatizing attitudes. It can also help people better recognize and understand mental illnesses as well as to find a suitable way to deal with them. 

Further information about courses in “mental health first aid” can be found at www.mhfa-ersthelfer.de. 

Specific ways to help

If you or someone close to you is in an acute crisis:

• Talk to the person affected and offer your support. In the event of doubt, always recommend professional advice or clarification. A general practitioner or emergency medical clinic is often the fastest available professional support.
• Accompany the person affected to an emergency medical clinic or their doctor’s practice.
• In the event of acute danger to yourself or a third party, dial 112 to call the emergency services.
• Alternatively, contact a clinic with a psychiatric ward and go to the emergency department.
• You can also call the non-emergency medical assistance number 116 117 and discuss available options.

Contact a crisis service in your area: a directory can be found on the website of the German Foundation for Depression Relief (Stiftung Deutsche Depressionshilfe).

If there is no danger to yourself or third parties but there is still an acute need for professional support, you can call qualified employees of the telephone counseling service TelefonSeelsorge.

For help dealing with stressful events, information can be found in the leaflet “How to cope with stressful events” from the Federal Office of Civil Protection and Disaster Aid (Bundesamt für Bevölkerungsschutz und Katastrophenhilfe).

Anyone who is directly or indirectly affected by violence can obtain support on the basis of the Crime Victims Compensation Act (Opferentschädigungsgesetz) of the Federal Ministry of Labor and Social Affairs (BMAS).