Us healthcare workers are often at the front line in emergencies. Taking quick action can help people get away from a crisis, obtain the proper help, and move forward in their lives. Taking care of emergencies was all we did at the Mental Health Urgent Care Center in Long Beach California, where I was on staff for 11 years. Here were the red flags we looked for:

1. Was a person in a medical crisis?

We took vital signs and asked them questions about medication, substance use, how much and how often, and how long ago was the last use. We also asked if they have any medical conditions, or allergies to medication or food, and then we would consult with the staff upon the findings. If a person was in a medical crisis, swift action was taken.

2. Was the person suicidal or homicidal?

These are serious questions because we are liable if the person goes out and kills themselves or another person. If they are suicidal, we would ask how serious their feelings are and how they plan to do it. This is key. If somebody is talking about these feelings, it can let some of the steam off, but if they wouldn’t agree to a safety plan, we would have to put them on a 72-hour hold and have them transported to a psychiatric hospital or if we had beds available, admit them into our psychiatric ward on the premises. If they needed to be hospitalized, it was important to tell them step by step what they were going to go through, and to keep them calm we would stay with them until the ambulance, or staff came for them. How would you like to be placed onto a gurney and rolled into an ambulance? For this reason, I ask people who call our facility in a crisis who need to be placed on a hold, to admit themselves into a psychiatric hospital themselves, so they don’t have to experience the ambulance ride. Plus, in volunteering in a hospital, it can be easier to get out on your own accord.

Now if somebody is homicidal, this needs to be taken seriously. Do they have weapons at home? Do they have access to this person? On a scale of 1–10, how likely are they to kill the person after they leave the facility? I for one make these people call the intended target and let them know they have these feelings. It’s humbling to let this secret out to the potential victim, but it will alert them that the person wants to harm them, so they can take action themselves, and it also serves as a way to vent these harbored feelings inside of the client in hopes of them reconsidering the feelings. If they feel they cannot resist these feelings, then it is off to the hospital for further evaluation and counseling, and usually some medication.

I’ve only had a few people in my career talk about wanting to harm people, and mostly it is from a person who has been horribly abused for a long time and wants to seek revenge. Therapy is key for them to purge these feelings and apply love to the part inside of them that suffered this treatment in the past. Or, should I say parts? Fritz Perls, from Gestalt Therapy, believes that if we suffer an emotional shock, there is a part inside of us that is stuck or “fixated” at that point in our lives. Therapy is therefore helping the person to process through that stuck part in order to heal. It is important to do this type of work with a trained therapist.

3. Child and Elder Abuse

We are legally and ethically mandated to report any type of abuse to children under 18 years old and to seniors over 60 years of age. Included in this group are dependent adults who have mental health issues and are dependent on others to care for them. Any type of abuse to these groups of individuals is taken seriously.

I’ve had to alert Child Protective Services (CPS) numerous times. I am the type who normalizes the situation and avoids shaming people. We are all human and sometimes our feelings can get the best of us, and I tell people this as I fill out the CPS forms with them. “The good news,” I usually begin, “is that you will go through counseling, go through parenting classes and anger management, and work through the difficult feelings you have inside so that your child will have a much better time growing up.” Though, this is when the person is in a calm state. Many individuals I’ve had to contact CPS on have had psychosis or were substance dependent and needed to go through substance treatment as well. Protecting individuals who cannot protect themselves is important for us in the healthcare industry.

4. Domestic Violence

I don’t need to state the numbers of people and their families that are affected by domestic violence, but in recent years we have seen these numbers skyrocket. The first action step is to get people safe! Many people think that it is usually men abusing women, though this is not always the case, in fact, I have treated more men who were abused than women. This may sound shocking, but people who are hurting inside tend to lash out at others and this has no gender bias. Unfortunately, we are in a society that will lock up the victims and punish them, before the real information gets out. If you or somebody you know is a victim of domestic violence, the first step is to get them to safety by getting them and the kids (if that is the case) away from the violence. There are shelters to admit them into that have resources, and counseling, and will act as a safe haven. There are many strategies you can use if you feel stalked and the first step is obtaining a restraining order so the person cannot approach you or they will be arrested. One thing to understand is that the abuse will not stop but only intensify.

CYCLE OF VIOLENCE: A couple gets really close, lots of love is being shared and suddenly one person feels smothered. It may be difficult for them to bond and they will start to feel trapped. Then the explosion takes place, which pushes the mate away. Quickly there is remorse. They can’t live without the other person and the courting process begins and builds. Eventually, the abused sees all the efforts and lets the person back in. Once again it is an incredible loving time and then BAM! The abuse happens again. This cycle of violence gets stronger and stronger and soon the victim can feel trapped and find it difficult to escape.

My sister recently went through this and was too ashamed to tell the family, so she put on the “Everything is Fine” mask and pretended she had a wonderful life. This was all for herself because we all knew what was going on but she needed to find her strength and get out of it herself. Oh, we were there and ready to spring into action, but you cannot live another person’s life for them. So we were relegated to frequent check-ins and eventually, she found her voice and got out of the situation. Unfortunately, many people get trapped for years in this situation. Yes, it may be hard to get out, but staying in the situation is basically you abusing yourself.

5. Substance Abuse

Here is a big red flag because in dealing with individuals who are under the influence, they may not be in their right mind. If you have ever been drunk or high or altered, you may think that you have it all together but here is where people get behind the wheel of a car and people die. How can we convince people they are altered, ruining their lives, and need to get help, and now? In my 29 years in the industry, this alone is the most difficult situation for me. People who are addicted to substances are used to being this way. When I think about it, people who are psychotic and hear voices and see visions are also dependent on that state. Who are we to try and stop them? Yes, they might be in a living hell, but it is amazing what the mind gets used to. To try and help people who are not in their right mind takes a lot of patience, effort, and honesty. Number one, you cannot make them change. My sister (another sister – I have a lot), who just got out of an Al-Anon meeting, called me and said she learned that she needed to let go of her son – my nephew. She couldn’t stop his using and the facilitator of the meeting said that people in this disease die. This is a harsh reality in our society. 20% of the people out there have serious mental health or substance use disorders that need serious treatment and only about 8% of these people are getting the help they need. How do we get people into treatment and then, what kind of treatment is out there for them that will actually work? Here is a huge subject that begs for another article because so many people are victimized in treatment or try to save money by attending the low bidder facility and it makes matters worse. Research facilities and see which approach they have and if it seems like a match. If it comes with a price, pay it. This is an expense that will make an impact on the rest of their life!  Read the reviews.

6. Severe Mental Illness

Untreated, mental illness can lead to murder, theft, abuse, and neglect. We see it on the streets where people are talking to themselves or going off in a fit of rage. Our prisons are filled with people that have mental illness and medical intervention is the key.

Often people want to come in for treatment, believing that counseling will help the voices, paranoia, and visions to go away, however, with psychosis, it is more of a brain ailment that responds only to medication. Now, counseling and medication are ideal for this condition because people can feel flawed and like an outcast. I personally didn’t understand severe mental illness until I needed to deal with that population at the crisis center. I thought that counseling was the one size fits all, but boy was I humbled when a woman came into the unit, was confused, and talking gibberish, then when our psychiatrist gave her some medication, she became normal and only in 20 minutes! I was amazed!

Here is the problem. Many who have psychotic disorders won’t trust medication so for professionals it is important to remain confident, caring, and assuring. Keeping these individuals on medication is tricky. For people who live with others, it is easier for them to stay with the medication. For others, who are on the street or isolated, there are injections of medication that last a month, which is helpful but doesn’t work as well as the tablets.

In closing. I think it is a symptom of this society to disregard people who are in trouble, turn the other cheek, and make believe that everything is going to right itself and things will be just fine. Unfortunately, that is not the case. When there is a problem, it is important to see the problem all the way through to the end. This is what Spiritual Psychology believes. It is the belief that things are happening in our lives for a reason and as we address this problem, we learn and grow through our efforts and become better people.