Jul 25, 2022

Interviewer: When it comes to your mental health, how do you identify when you are actually in a crisis and when you might need some emergent or immediate help?

To help us answer this question, we're joined by Natalie McClintock. She's a licensed clinical social worker for the Huntsman Mental Health Institute, formerly known as the University Neuropsychiatric Institute.

Now, Natalie, when it comes to our mental health, we've all had bad days, we've all dealt with anxiety, some people have dealt with depression, but when does it become a crisis? When does it become something more serious that someone should really seek some professional help for?

Natalie: When we're looking at hospitalization, we're looking at someone who is in acute crisis. So one of our jobs as someone in admissions at a hospital is to meet with patients that are currently suicidal, have an active plan, and intent.

Now, that plan and that intent and that level of suicidality can differ from person from person, but that is not the patient's role to determine. That's why we have licensed professionals who are willing to meet with them and talk with them and connect them with the appropriate resources.

Interviewer: I guess one of the questions I have then is if it is not up to, say, a patient or an individual who's dealing with an acute crisis like this, what signs should they look for to identify that they should probably reach out to someone?

Natalie: When we're talking about suicidal patients, please reach out if you are having thoughts of actively wanting to harm yourself. If you are looking for a gun or looking for medications to overdose on, that is a good sign that you may need some help.

Outreach for hospitalization if you're starting to develop a plan, if you are starting to think, "I'm thinking maybe I'll go and drive somewhere and just see what happens." The plan doesn't have to be concrete. If you're just starting to think of what that plan would be, a good indication that you need some help.

The other thing is to look at your level of intent. Now, the important thing to remember with intent is studies show that intent can happen within 10 minutes of the actual suicide attempt. So if you're starting to think of a plan, or just thinking that you are wanting to die, you may not feel like you would ever do that, but again, that intent can happen within 10 minutes. So it's very quick.

Interviewer: Wow. So this is kind of an emergent situation, something that you should probably get immediate help.

Natalie: Yes. Just like if you were bleeding, or in a car accident, or having stomach pain, mental health is just as important to seek help for.

Interviewer: Yeah, it's potentially as life-threatening.

Natalie: It is. And not getting the help that you need and deserve is definitely life-threatening. Outside of suicidal ideation, if you are significantly depressed, and you're not going to work, you're not taking care of your activities of daily living such as showering, taking care of your family, eating, sleeping, you're scared to go outside, those are also some signs that you may need some hospitalization and further help.

Interviewer: So it's not just suicidal thoughts. It's also if your life is being severely impacted, and if you're on the road to a depressive episode, etc. Those are also reasons to reach out.

Natalie: Absolutely.

Interviewer: Before you're in crisis.

Natalie: I would argue that what we call a significant decline in functioning is a crisis. It is threatening your day-to-day life. You're no longer able to function, and that's a crisis.

Interviewer: What about, say, family members or friends or loved ones who may be concerned about someone else? What should someone in that situation where they have someone in their life that they care about who seems to be showing some of these signs, what should they do? What should they be on the lookout for?

Natalie: They need to outreach as well. A lot of patients and individuals, they have a lot of good insight in when they need help and when they are in crisis, especially if you deal with depression and suicidal thoughts consistently. These patients have good insight. Some patients don't, and they need the help of their family and the community to help advocate for them.

So absolutely, family members can call to the hospital, to other crisis services that we can talk about a little bit later, to help connect their family members and their friends and loved ones to those services.

Again, you're going to be looking for the same thing. Are they starting to withdraw more? Are they starting to give away possessions? Are they starting to talk about no longer wanting to be around? Those are important signs. Again, same with the decline in functioning. Again, are they withdrawing? Are they not taking care of themselves?

One patient population that it is difficult in that they don't have a lot of insight based off of the illness are patients that are suffering from psychosis, whether they have schizophrenia or even bipolar with a manic component. Those patients need more advocacy from their family and the community because there's not a lot of insight.

So are they spending a lot of money? Are they impulsively putting themselves in danger? Extreme examples are walking on the side of the road in the winter with no shoes. Or are they leaving their stove on? Things of that nature are things to watch out for with these patients. Again with the mania, are they spending a lot of money? Are they becoming sexually promiscuous? Are they quitting their job?

Interviewer: I guess as kind of a layperson, one of the things that I'm always worried about, if I see in my friends, in my family, some of these . . . maybe not the more severe signs, but just depression. I always worry about asking, right? Am I going to make the situation worse by being like, "Oh, are you feeling depressed?" or, "Oh, have you had suicidal thoughts?" I always worry that me asking is somehow going to make it worse. Is that true?

Natalie: The important thing is to make sure that they're safe. Asking if someone is suicidal or becoming suicidal does not put that idea in their head. They're already getting to that point. The important thing is to help connect them to a hospital or to a mental health professional that can get them the help that they need.

Interviewer: So I'm safe to ask those types of questions. It's not like I'm making the situation worse.

Natalie: No. Now, some patients may become defensive and deny. But if you have significant concern for their safety, again, outreach to the appropriate authorities and the mental health professionals to get them the help, and we can help get them into the hospital and get them connected to the appropriate resources.

Interviewer: So why don't we talk about that a little bit more? We've discussed what signs to look for in yourself, what signs to look for in others, the importance of getting help. I think for a lot of people, myself included, if I were having these thoughts, I don't even know what the first step is. Do I call 911? Do I call my doctor, my priest? What is the kind of procedure or step-by-step? If you find yourself or a loved one in crisis, what do you do first?

Natalie: Here, locally, in Utah, we have the Community Crisis Intervention and Support Services. This service includes a crisis line and a warm line. And those are clinical professionals and peer support specialists who can help walk through any questions that you may have, whether it's individually outreaching or outreaching on behalf of a family member or loved one. They are trained to answer any questions that you may have about mental health, about people in crisis, and what the next steps should be. It is a free service.

The other service that they offer is the Mobile Crisis Outreach Team. That is a social worker and a peer-support specialist. And I think I should make it clear that a peer-support specialist is someone who has gone through mental health, either gone through, or continuing to go through it and seeking treatment. They go out to the community to where the patient is and meets with them in their own environment.

And that can be a great resource, especially since going into a hospital can be scary. And they can help walk through what that process would look like. So that's a great resource to be aware of.

The SafeUT app is also a great resource. Individuals who may be in the younger demographic, teenagers, young adults, calling may not be what they feel comfortable with. They feel more comfortable texting, and so that SafeUT app is a chat line. It's a text line that you can outreach to someone. It's manned 24/7, and it can also be anonymous. So that is also a great resource for you to outreach for yourself or for someone else.

Nationally, there's also a 988. So how it currently stands is there's a National Suicide Hotline that anyone can call nationwide and it will connect you to a certified mental health provider in your state. And so the crisis line here at Huntsman Mental Health Institute, we are the answering service for that.

Interviewer: Wow. So anyone, anywhere, if they're having these types of thoughts, if they find themselves in any crisis state, they can call 988 and it will connect them to their local resources?

Natalie: Yes. And it's a number that you can easily remember just like 911.

Interviewer: What is the number that people can reach out to locally in Utah to make sure that they can get either through to the crisis line or the warm line?

Natalie: 801-587-3000 and that will connect them to the warm line, the crisis line, and MCOT. The app for SafeUT is just SafeUT.

Interviewer: On any app store?

Natalie: On any app store.

Interviewer: Fantastic. So again, mental health is as important as physical health. And if you're in any sort of emergency, you should get some professional help. Natalie, thank you so much for joining us, and thank you so much for caring about mental health.

Natalie: Thank you for having me.

For Patients