Mental-Health Emergency and Safety

Stories, signs to notice and what to do

The Message at Midnight

Dev, 24, a colleague of Mira's in Mumbai, sends a late message that says, "Tell the team I am sorry for everything. I won't be a problem any more." Mira has noticed he has been withdrawn and has given away some of his belongings. Her stomach drops.

She calls him at once. He answers quietly. She says, "I got your message and I am worried. Are you thinking of ending your life?" After a long silence, he says yes. She stays calm, thanks him for telling her and asks where he is. He is at home alone.

Mira says she will not leave him alone, that she is coming over, and asks him to put aside anything he might use to hurt himself. She calls his brother, who joins them, and together they take Dev to the nearest hospital emergency department. On the way Mira listens and does not argue or lecture.

The doctors assess Dev and arrange care. In the weeks after, the family and workplace support him with follow-up and a safety plan. Mira says later, "Asking directly did not put the idea in his head. It opened the door." At work, a manager arranges flexible hours and the team quietly checks in on him, without gossip or pity. Mira also speaks to a counsellor herself, because the night was heavy for her too.

How to recognise it

• Statements about being a burden or wanting to disappear.
• Giving away belongings or saying goodbye.
• Withdrawal and sudden calm after deep distress.
• Hopelessness, sleep and mood changes.
• Previous attempts or major recent loss.

What this story explains

Recognising suicide risk and responding quickly means listening, asking directly, not leaving the person alone and getting immediate professional help.

Probable root causes

• Depression or other mental illness.
• Overwhelming stress or loss.
• Isolation and hopelessness.
• Easy access to means of harm.
• Previous attempts.

What to do

1. Take any hint seriously.
2. Ask directly and calmly about suicide.
3. Stay with the person and keep them safe.
4. Remove or secure anything that could be used for harm.
5. Call the local emergency service or go to the nearest hospital.
6. Involve trusted family or friends.

Whom to consult

• Emergency service or nearest hospital right away if there is a plan or intent.
• Psychiatrist for assessment and follow-up care.
• Clinical psychologist or counsellor for ongoing support.

Do and don’t

How to behave and communicate

• Ask plainly: "Are you thinking of ending your life?"
• Say: "I am here. You are not alone."
• Listen without lecturing.
• Stay calm and speak slowly.

The Night the Neighbour Stopped Sleeping

Mrs Dsouza, 45, in Bengaluru, had been unwell for years and stopped her medicine last month. For four days she has not slept, believes the neighbours are poisoning her water, and has covered the windows. Tonight she is shouting at the door and has a kitchen knife in hand, saying she must protect herself.

Her son Peter, 20, is frightened. He keeps his distance, speaks softly, does not challenge her belief and asks his aunt to call the local emergency service. He keeps the door open so she can leave the kitchen, and removes small children from the room.

When the team arrives, Peter explains what has happened, that she stopped her medicine and has not slept. They speak calmly, and take her to hospital. She is frightened, but after some days of treatment and sleep she is calmer.

Afterwards the family and doctor build a plan: regular medicine, follow-up visits, and early warning signs, such as sleeplessness and suspicion, that mean they call the doctor sooner. Peter says, "I learned that safety comes first, and that I did not cause this." The neighbours, who had been frightened too, later bring food and ask how they can help, which makes the family feel less ashamed. Peter learns that calling for help early was a loving act.

How to recognise it

• Several nights of no sleep and strong fear or suspicion.
• Strange beliefs, hearing voices, or confusion.
• Threatening behaviour or holding a weapon.
• Recent stopping of regular treatment.
• Risk to self or others.

What this story explains

Severe psychosis or mania, and risk of harm to others, are emergencies. The priority is safety, calm behaviour and urgent professional help.

Probable root causes

• Relapse of a severe mental illness.
• Stopping treatment.
• Sleep loss.
• Stress or substance use.

What to do

1. Keep yourself and others safe and keep distance.
2. Do not argue with the beliefs.
3. Speak softly and give her space.
4. Call the local emergency service if there is danger.
5. Tell the team clearly what happened and what treatment she had.
6. Arrange follow-up and an early-warning plan afterwards.

Whom to consult

• Emergency service or nearest hospital immediately when there is a weapon, threat or risk to anyone.
• Psychiatrist for treatment and relapse prevention.
• Family doctor for support and guidance afterwards.

Do and don’t

How to behave and communicate

• Speak low and slow: "I am here. No one will hurt you."
• Do not shout or threaten.
• Use short sentences.
• Acknowledge her fear without agreeing to the belief.

Too Much, Too Fast

At a college party in Goa, Kunal, 20, drinks heavily after his friends dare him. Later he is slumped on a sofa, hard to wake, breathing slowly, and skin cool and clammy. Some friends laugh and say, "Let him sleep it off."

His friend Shreya is uneasy. She tries to wake him and he barely responds. She says firmly, "This is not sleep. We are calling for help." She calls the local emergency service while another friend turns Kunal onto his side so he will not choke if he vomits.

They stay with him, watch his breathing, and tell the responders how much and what he drank and how long ago. They do not give coffee or a cold shower, and do not leave him alone.

At hospital he is treated and recovers. Afterwards the friends talk. Kunal is embarrassed, but Shreya says, "We would rather you be annoyed than gone." He decides to speak to a counsellor about his drinking, and his friends agree to look out for each other. The group also agrees that next time nobody will push anyone to drink more, and that someone will always stay sober enough to look out for the others. Kunal's parents are told, and respond with worry rather than anger.

How to recognise it

• Cannot be woken, slow or irregular breathing.
• Cold, clammy or bluish skin, vomiting while drowsy.
• Confusion or seizures after drugs or alcohol.
• Friends dismissing it as sleeping it off.
• Possible mixing of substances.

What this story explains

Substance-related emergencies need quick action. Calling for help, staying with the person and giving clear information can save a life.

Probable root causes

• Heavy drinking or drug use.
• Peer pressure and dares.
• Mixing substances.
• Lack of knowledge about warning signs.

What to do

1. Try to wake the person and check breathing.
2. Call the local emergency service immediately.
3. Place them on their side and stay with them.
4. Tell responders what was taken and when.
5. Do not leave them alone.
6. Follow up with support once safe.

Whom to consult

• Emergency service or nearest hospital at once.
• Family doctor afterwards for health review.
• Counsellor or addiction specialist if use is risky or repeated.

Do and don’t

How to behave and communicate

• Speak clearly to responders.
• Call the person by name and speak calmly.
• Afterwards say: "We were worried because we care."
• Listen without lecturing.

Four Lines on a Card

After a hospital stay, Anjali, 32, in Delhi has made it through a very dark week. Her counsellor suggests building a safety plan together on one page. Anjali is nervous, but she writes it in her own words.

First, her warning signs: not sleeping, staying in bed all day, thinking she is a burden. Second, things she can do alone: a shower, music, stepping outside, holding a cold cloth. Third, people she can contact: her sister, a close friend, and her counsellor. Fourth, steps to make her home safer, with her brother keeping medicines locked away, and the local emergency service and nearest hospital written clearly.

Her sister keeps a copy and learns what to do. They agree to check in daily for the first weeks, and Anjali has follow-up appointments booked.

Some days are still hard. One evening she notices the warning signs, uses her list, and calls her sister, who comes over. Anjali later says, "The card gave me something to do when my mind went blank." Her family learns that recovery after a crisis takes time, and they stop avoiding the subject. She updates the card after each rough patch, adding a new calming activity or an extra friend to call, and her counsellor reviews it with her at each visit. Slowly she begins to trust herself again.

How to recognise it

• Recent crisis or hospital stay.
• Known warning signs such as poor sleep and withdrawal.
• Need for a clear plan that others also know.
• Risk remaining high in the weeks after a crisis.
• Family unsure how to talk about what happened.

What this story explains

A safety plan lists warning signs, coping steps, people to call and ways to make the environment safer. Support after a crisis matters as much as the emergency itself.

Probable root causes

• Underlying depression or other mental illness.
• Recent stress or loss.
• Isolation after discharge.
• Access to means of harm.

What to do

1. Write the plan with a counsellor or doctor, in your own words.
2. List warning signs, calming activities and trusted contacts.
3. Make the home safer by securing medicines and other risks.
4. Share the plan with family or friends.
5. Keep follow-up appointments.
6. Review the plan after each rough patch.

Whom to consult

• Psychiatrist or clinical psychologist for follow-up and building the plan.
• Family doctor for ongoing health care.
• Emergency service or nearest hospital whenever safety is at risk.

Do and don’t

How to behave and communicate

• Say: "I am glad you are here. How can I support you this week?"
• Listen without pressing for details.
• Check in gently and regularly.
• Respond calmly to warning signs.

The Sixteen-Year-Old's Notebook

Sameer's mother, Anita, 44, in Pune, found her son Sameer's notebook with lines about being a burden and wanting to disappear. He is 16, quiet, and recently lost his place in the cricket team. She feels sick but decides not to panic or punish.

That evening she sits with him and says, "I read what you wrote. I am not angry. I love you and I am worried. Are you thinking about ending your life?" Sameer starts to cry and says sometimes at night he does. She holds his hand and thanks him for telling her.

She stays with him, tells his father, and quietly secures medicines and sharp tools at home. The next morning they call the family doctor and a school counsellor and arrange an urgent appointment. She tells Sameer that if he ever feels he might act on the thoughts, they will go straight to the nearest hospital or call the emergency service.

Over the following weeks, the family eats together, keeps his sleep regular and meets the counsellor weekly. Sameer says later, "I thought I would be in trouble. I was surprised she just listened." His father, who had always kept his feelings hidden, tells Sameer about a hard time in his own youth, and father and son talk more than they have in years. Anita keeps the notebook, and gives it back to him only when he is ready.

How to recognise it

• Written or spoken comments about being a burden or disappearing.
• Recent loss, humiliation or rejection.
• Withdrawal, changes in sleep and mood.
• Secretive behaviour or a hidden diary.
• Warning signs that a young person cannot easily say aloud.

What this story explains

Teenagers may show suicide risk through writing or small hints. A calm response means listening, asking directly, securing the home and getting professional help quickly.

Probable root causes

• Depression or overwhelming stress.
• Loss of status or belonging.
• Shame and fear of punishment.
• Impulsiveness typical of the teenage years.

What to do

1. Stay calm and talk privately.
2. Ask directly about thoughts of suicide.
3. Stay with him and tell the other parent.
4. Secure medicines and other harmful items at home.
5. Contact the doctor or school counsellor urgently.
6. Go to the nearest hospital or call emergency services if he may act.

Whom to consult

• School counsellor and family doctor as an urgent first step.
• Child and adolescent psychiatrist or psychologist for assessment and treatment.
• Emergency service or nearest hospital immediately if he has a plan or cannot be kept safe.

Do and don’t

How to behave and communicate

• Say: "You can tell me anything. I will not be angry."
• Keep a gentle, steady voice.
• Thank him for telling you.
• Listen more than you speak.

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.