What to Expect During a Crisis Assessment
***CONTENT NOTE: This post discusses suicidal thoughts and being in a hospital. No graphic details.***
It is my sincere hope that no one reading this ever feels like they want to seriously harm themselves (e.g. attempt suicide), but the reality is that suicidal thoughts are very common and sometimes escalate to a point where they are difficult to manage. Sometimes when this happens, you or your therapist may decide that it might be helpful to have what’s often called a “crisis assessment", to have a better idea of how safe you are and what kinds of resources might be helpful to you. Like most things that are unfamiliar, a crisis assessment may seem scary if you’ve never had one, so I’m going to walk you through what the process can be like. Hopefully this can give you a sense of familiarity and help you feel empowered if you are ever in this situation.
***Please note that the following information is based on my past experience as a crisis clinician. Different places and people vary in exact procedures, so some details of your experience may vary bit from what I talk about here. Still, I hope it is a helpful general guideline for what you might expect. Please consult with your own provider or someone from your local crisis center for more accurate information about what typically happens in your area and how things might be done in your case.***
First, let’s talk about when you might have a crisis assessment done. There are of course an infinite number of individual factors to consider, but generally an assessment would be recommended if someone has been struggling with their mental health to the point where they have been thinking about suicide for a while, or if something bad suddenly happens and someone starts feeling very suicidal (e.g. wanting to hurt themselves, planning out how they would do so, etc.) very quickly. An assessment also might happen if someone is otherwise really struggling to take care of themselves or is a serious threat to someone else.
There are two main places that you could go to for an assessment: the emergency room, or a mental health crisis center. Most of what would happen at each of these locations is the same, with a couple of differences. A first step might be to find the crisis center that serves your area (tip: google “crisis center ________ county”, or see my list below this article if your are located in Massachusetts), and then call them to see what they might recommend, in terms of going to the office, to the hospital, or even if they can come to you. If you would prefer to do so or if your area does not have a crisis center, you can also go directly to the hospital emergency room near you.
Once you are at the clinic or emergency room, you likely have to wait in a waiting room and fill out some paperwork. This can include contact information for your therapist if you have one, basic history, insurance information, and privacy agreements that you are probably used to signing when you go to any other provider, like your primary care or your dentist. If you are at the emergency room, they will also likely do their standard triage procedures — asking about pain, taking your blood pressure, and possibly some blood work. This does not tend to happen at a crisis center.
After you have completed the paperwork, a mental health clinician will take you to a private room to begin the assessment. They typically might start by asking what led you to have a crisis assessment and talk about how things have been for you recently. They also are likely to ask about treatment history, substance use, trauma history, and any other relevant details. They also are likely to ask about your thoughts to hurt yourself. For example, do you want to hurt yourself? Have you thought about how you would do so? Your answers to all of these questions helps to determine what happens next.
Next, you and the clinician might talk about supports that you can use to get through the difficult time that you are having. You might be referred to a therapist if you don’t already have one, to a day treatment center, a voluntary hospital stay, or another resource. All of these choices are optional, unless the clinicians are so concerned for your safety that the need for involuntary hospitalization is present. This is not unheard of but does happen occasionally.
Most of the time, people who have crisis assessments go home or go to a program that they agree to. Individual circumstances vary, but generally involuntary hospitalization is sought when someone is at a very high imminent risk to harm themselves now and the clinician has reason to believe that the person cannot keep themselves safe in the very near future (e.g. next few hours/days). This is not a decision that is taken lightly, and is really done as a last resort if there is a serious and immediate safety concern that can’t be worked with in any other way. If a person can rely on other resources that they use voluntarily, we would always prefer to be able to do that. There are many things that a clinician would consider before hospitalizing someone involuntarily, but I mention it here to be transparent about the process — involuntary hospitalization is rare, but it is a possibility.
At some point in the assessment, the clinician will likely step out for a couple of minutes to consult with their supervisor. Making sure that helpful decisions are being made is really important, and having someone else to consult with can help clinicians to make sure that they haven’t overlooked anything that could be helpful to you (and to have a second person confirm or disagree that involuntary hospitalization is necessary, if that is what the clinician is considering).
After that, the assessment is over and it’s time to implement the plan. In most cases, this means that the person goes home and makes an appointment with a therapist, or waits to hear back from a program that the crisis clinician referred them to. If a person is going to the hospital, this might mean going to or staying in the emergency room for a bit while the clinician looks for nearby hospitals that have openings. Or, the plan could even be to spend time with a friend who is supportive.
***Again, please remember that your individual circumstances may vary. The information contained in this article is not meant to tell any particular individual what will or will not happen during a crisis assessment. Remember that in order to provide helpful information, I have needed to make some generalizations, so please contact your own provider or local crisis center if you have questions about your own situation.***
24-hour Crisis Centers by County, Massachusetts
Barnstable County: Cape and Islands Emergency Services, 508-775-2683
Berkshire County: The Brien Center, 1-800-252-0227
Bristol County: Community Counseling of Bristol County, 800-660-4300
Dukes County: MV Community Services, 508-693-0032
Essex County: Beth Israel Lahey Health, 978-455-3397
Franklin County: Clinical & Support Options, 413-774-5411
Hampden County: BHN Crisis, 413-733-6661
Hampshire County: Clinical & Support Options, 413-586-5555
Middlesex County: BMC Emergency Services, 1-800-981-4357
Nantucket County: Fairwinds, 877-784-6273
Norfolk County: CCBC Emergency Services Program, 508-580-0801
Plymouth County: Child & Family Services, 1-877-996-3154
Suffolk County: Boston Emergency Services Team, 800-981-4357
Worcester County: UMASS Memorial Health, 866-549-2142
