A behavioral emergency occurs when one or more individuals act abnormally in ways that are unacceptable or intolerable. This includes persons who behave erratically or who present a danger to themselves or others.
A thorough scene size-up is extremely important for behavioral emergencies. Even if the scene is otherwise safe, a potential for violence or other intolerable behaviors can put you and others around you at risk. Modify your assessment of the scene and victim as follows:
- Observe the person’s general appearance, looking for any sign of confusion, aggression, or panic
- Look for specific signs of a behavioral emergency, including:
- Intense emotional reactions like fear, anxiety, anger, agitation, or withdrawal
- Extreme stress
- Bizarre thought processes or actions
- Disconnection from reality
- Unusual speech patterns, slurred speech, excessive salivation
- Strong odors, unclean clothing, loss of bowel or bladder control
- Altered level of consciousness
- Identify any threatening, aggressive behavior and/or the presence of a weapon
After you determine the scene is safe, approach a person having a behavioral emergency with caution. Always be prepared for a potential threat by keeping your eyes on the patient at all times; by using calming, nonthreatening speech and body language; and by being ready to retreat to a safe distance if violence seems ready to erupt.
The following specific conditions/disorders can result in a behavioral emergency.
Anxiety and panic disorders
All people experience some fear and anxiety as a result of stress. A person with an anxiety disorder experiences extreme anxiety or panic attacks that interfere with the person’s ability to lead a normal life.
- Anxiety disorders (TeenHealth)
- Anxiety disorders (WebMD)
- Generalized anxiety disorder (Mayo Clinic)
- Panic attacks (Mayo Clinic)
- Panic attacks (MedicineNet)
Bipolar disorder is a mental illness in which the patient experiences mood swings from the extreme lows of depression to the highs of mania.
Depression is a recognized mental illness in which the patient feels unexplained sadness, feelings of uselessness or hopelessness, and suicidal thoughts.
Conduct disorder is a serious emotional and behavioral condition in which children or teens display a pattern of disruptive or violent and a difficulty following rules.
Excited delirium syndrome
Persons with excited delirium exhibit agitation, violent tendencies, increased strength, insensitivity to pain, and high body temperature. This syndrome is often associated with drug abuse.
Paranoia is a medical condition characterized by feelings of persecution and exaggerated notions of perceived threat. It is usually part of other mental health disorders and is rarely seen in isolation.
Schizophrenia is a severe mental illness in which the patient experiences delusions, visual and auditory hallucinations, suspicions and paranoia, inappropriate emotional responses, social isolation, and lack of personal hygiene.
Behavioral emergencies often lead to violence. Patients experiencing a behavioral emergency may have no control over their thought processes, feelings, or actions. In addition, low blood sugar, lack of oxygen, drug abuse, and head trauma can all contribute to a violent reaction during a behavioral emergency.
Restraining or subduing a violent patient is beyond the scope of practice of most first aiders, lifeguards, and EMTs. An emergency call should be initiated at the first signs of a behavioral emergency and law enforcement personnel should be summoned to the scene along with EMS.
- Self-injury (Mayo Clinic)
- Sexual assault (eMedicineHealth)
- Suicide prevention (AFSP)
- Suicide prevention/intervention (HelpGuide)
- Violence prevention (CDC)
- Violence prevention (WHO)
Mental Health First Aid
Mental Health First Aid is a groundbreaking public education program that helps the public identify, understand, and respond to signs of mental illnesses and substance use disorders. Mental Health First Aid USA is managed, operated, and disseminated by three national authorities — the National Council for Community Behavioral Healthcare, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health.
Mental Health First Aid is offered in the form of an interactive 12-hour course that presents an overview of mental illness and substance use disorders in the U.S. and introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, and overviews common treatments. Those who take the 12-hour course to certify as Mental Health First Aiders learn a 5-step action plan encompassing the skills, resources and knowledge to help an individual in crisis connect with appropriate professional, peer, social, and self-help care.
The 12-hour Mental Health First Aid USA course has benefited a variety of audiences and key professions, including: primary care professionals, employers and business leaders, faith communities, school personnel and educators, state police and corrections officers, nursing home staff, mental health authorities, state policymakers, volunteers, young people, families and the general public.
Additional information about this program and related legislation, follow the links below: