Clinical Review

ABC of mental health: Mental health emergencies

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7096.1740 (Published 14 June 1997) Cite this as: BMJ 1997;314:1740
  1. Zerrin Atakan,
  2. Teifion Davies

    Introduction

    An emergency is a situation that requires immediate attention to avert a serious outcome. Mental health emergencies range from situations where a patient is at risk because of intense personal distress, suicidal intentions, or self neglect to those where a patient places others at risk. Some patients may behave in an aggressive manner, make threats, or act violently. Such behaviour may produce physical or psychological injury in other people or damage property.

    Causes of mental health emergencies

    What makes a situation an emergency depends on the individual patient and the circumstances. Surprisingly, patients with mental disorders are more often the victims than the perpetrators of violence. They are often feared by the public, and this may render them vulnerable to assault. A patient's own health is often at risk from his or her behaviour, as in attempted suicide or severe depression. Other people may be more at risk of neglect or accidental involvement than of intentional violence.

    In difficult circumstances almost any patient may behave violently and pose a risk to their own safety or that of others


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    Not all emergencies involve psychotic disorders. Neurotic disorders such as acute anxiety or panic disorder can cause chaotic or dangerous behaviour. Misuse of alcohol or illicit drugs may increase a patient's vulnerability, risk taking behaviour, and propensity to violence. The recent increase in suicide rate among young men seems to be due to social and psychological factors rather than recognised mental disorder.

    Some mental health emergencies

    Immediate risk to a patient's health and wellbeing
    • Nihilistic delusions or depressive stupor (stops eating and drinking)

    • Manic excitement (stops eating, becomes exhausted and dehydrated)

    • Self neglect (depression, dementia)

    • Vulnerability to assault or exploitation (substance misuse and many mental disorders)

    • Sexual exploitation

    Immediate risk to a patient's safety
    • Suicidal intentions (plans and preparations, especially if concealed from others)

    • Deliberate self harm (as result of personality disorder, delusional beliefs, or poor coping skills)

    • Chaotic behaviour (during intense anxiety, panic, psychosis) …

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