It was a call she had to take. It didn’t matter that it happened to come during an important business meeting and she was one of the rising sales executives at a high-profile company. She knew it might save his life.
Jess saw that Mark had called twice in a row (their code for “I’m in trouble — help”), and she had to call him back. Now.
Mark suffers from major clinical depression. He and Jess had been friends since they were teenagers, when Jess was battling an eating disorder.* Years ago they came up with the call-twice code so one of them could talk the other down from tough moments: suicidal thoughts, urges to binge. The idea was to intervene before a difficult time became a true emergency.
Although mental health is no longer as taboo as it used to be, we still don’t like to think of the big “what if” situation. What if my friend wants to kill herself? What should I do when he’s having a panic attack? What if my roommate is hysterical and I don’t realize what is going on?
These aren’t fun questions, but they’re important ones. Lifesaving questions, in fact. If you know anyone who has depression, bipolar disorder, anxiety or another mental health condition, they are vital questions to answer.
And, fortunately, the answers are simpler than you might think.
Why You Need a Pre-Emergency Plan
The standard advice is that if you’re seriously thinking of harming yourself or others, you should go to the emergency room. And, please, if it’s that serious, go there immediately.
However, there’s a vast spectrum of desperation between “I feel depressed” and self-harm.
A plan isn’t morbid or overreacting. It’s practical, responsible and considerate.
I’m all too familiar with this in-between, pre-crisis place. While I’ve never actually harmed myself, I’ve had weeks when I thought about killing myself daily. I’ve had days when I’ve cried hysterically until I wore myself out and fell asleep. I’ve had my husband hold me for hours as I talked about how I felt worthless (he’s a hero).
“When people are in crisis, they can really do one of two things,” says Marc Skelton, Ph.D., a licensed clinical psychologist in Laguna Niguel, California. “At first, they may be able to depend on their own internal resources — talk themselves down or distract themselves. If that doesn’t prove effective, it’s definitely time to look to their environment — to reach out for social support or call a hotline.”
In other words, family and friends can be a vital second option when your own coping strategies don’t work. They can block the flow of negative thoughts — or at least help you turn it down — when you’re unable to do so yourself.
5 Things Everyone With Depression Needs to Do
Creating a what-if plan sounds like a daunting task, but it’s really not. In fact, we've created a printable checklist to make creating your plan a little more manageable. Scroll down to the bottom of the article to print it out.
Preparing for a mental health flare-up is empowering not only for you, but also your friends and family, says Claudia David, Ph.D., a psychologist and family therapist based in Santa Monica, California. “It’s best to create an emergency plan when everybody is feeling well so that if a crisis arises, there is a feeling of some control.”
Don’t wait for the aftermath of a crisis to talk about a “what if” or emergency scenario.
If you’re the friend of someone who battles a mental health condition, don’t be afraid to bring up the topic. “To address it directly is important,” Skelton says. “One thing that happens quite frequently is that people tend to ignore it and hope it goes away. People in crisis or near crisis appreciate direct, supportive dialogue.”
“It takes some time to develop a plan, so know that it may take a couple of sittings,” David says. Discuss the plan with your counselor and your family, she recommends.
Here are some things you can start doing today to prepare for troublesome times.
1. Program the National Suicide Prevention Hotline into your phone.
It’s 1-800-273-8255, and it’s available 24/7. They also have an online chat option now, which is good to bookmark on your phone or laptop. If your insurance or hospital has a behavioral health helpline, program that into your cell too.
If you’ve ever wondered what happens when you call a behavioral health helpline, let me tell you — because I’ve had to call. The person answering the phone will listen to you like a supportive friend. They’ll say all the right things to calm you down and make you feel better. Once you’re in a better place, they’ll help you with next steps, such as setting up a counseling appointment.
If you’re thinking, “I just really need someone to talk to right now,” call a hotline. The volunteers are trained to say exactly what you need to hear.
And we can’t stress this enough: If you or someone you love is suicidal, call 911.
2. Give your spouse/bestie the hotline number, and let them know when to call it.
Your closest friends and family members should have the number in their phones too (again: 1-800-273-8255).
Depending on your living situation, it might also be a good idea for your roommates to have it. (They’ll probably be the first ones to notice that you’re having a panic attack or haven’t left your room in three days.)
Let them know that it’s OK to call it and under what circumstances they should do so. In my case, my husband has my blanket permission to call our hospital’s behavioral health hotline whenever he thinks it’s warranted.
Another option: Tell your loved ones it’s OK to call it for you when you give them permission. After all, in the middle of a crying fit, it can be very helpful for a friend to call and explain what’s going on before you get on the line. Do whatever helps you feel secure and comfortable.
3. Set a “call me now” code with a couple of friends.
When you have depression, sometimes it just takes a phone call with a good friend to stop your brain from spiraling down a darker and darker path. (And, to be fair, sometimes it takes much, much more.)
But how does your friend know you’re calling because you’re in crisis versus just wanting to gossip about the Brangelina breakup? Have a code that signals “I’m in trouble — call me now.”
Some possible codes include:
- Calling twice in a row without leaving a voicemail
- Sending a text message that says “SOS”
- Having a special phrase for social situations that subtly indicates, “I need to leave.”
You don’t have to do this with all of your friends — only the ones who you know will be supportive and open to the idea. “I would encourage people to talk with a family member or friend whom they trust enough to handle the information calmly,” Skelton says. “If you can identify one person you can trust in this way, you can be somewhat secure that they’ll take that knowledge and try to help you with it.”
I’ve found that friends who have mental health concerns are especially open to this, since they can also use the code themselves when they need to talk with you asap.
4. Let people know how to help.
I have one friend who absolutely needs to be left alone when a panic attack hits. I know someone else who needs to talk it out for the attack to subside.
Likewise, I don’t always need reassurance and kind words when I’m in a severely depressed state. Sometimes, the best thing for me is to go shopping with friends and talk about normal things. (It helps me get out of my head for an hour or two.)
“If you’re in a period in which a crisis hasn’t occurred yet, and you’re letting others know that you may need their help in the future, then a continuation of that discussion would be how they can help you,” Skelton says. For example, you could say, “If you see that I’m isolating myself, ask me to do something.”
You can also talk about what’s worked for you in the past. Something like, “Last time, I felt a lot better after cuddling on the couch with you while we watched a movie.” This gives others some direction instead of them having to figure it out all on their own, Skelton says.
5. Create and share an emergency phone list.
This is a good thing to do in case of any emergency, not just a mental health crisis: Write out a list of phone numbers for important people in your life and your health care providers, and then email it to your family and close friends.
You don’t have to be specific about what it’s for. Just say that it’s in case of an emergency. Be sure to include your counselor and psychiatrist on the list, David recommends.
Give Your Friends (and Yourself) Peace of Mind
Keep in mind, this isn’t an exhaustive list of steps to take. David recommends filling out the crisis plan at mentalhealthrecovery.org, which includes a self-help plan, signals of worsening mental health and other important information.
“Print out some of these lists for your loved ones to have so that when you call them, they can have [the lists] to help you out,” David says. “This will give them peace of mind.”
Use our handy checklist to get the ball rolling. There's also a PRINTABLE version.
Remember, this isn’t just for you. Having a loved one with depression or another mental health disorder is scary. Knowing that your wife or daughter sometimes wants to kill herself is terrifying. Don’t wait for the aftermath of a crisis to talk about a “what if” or emergency scenario.
Putting a plan in place acknowledges not only that you care about yourself, but that you also care for them. It means that you don’t want to put them in a position in which they don’t know what to do.
A plan isn’t morbid or overreacting. It’s practical, responsible and considerate.
*Names have been changed to respect their request for privacy.