When a family member is in a mental health crisis

A mental health crisis is when a person's thoughts, mood or behavior put them at risk, or they can no longer care for themselves. It might be talk of suicide, seeing or hearing things that are not there, wild agitation, or not eating or sleeping for days.

When it is someone you love, it is frightening. You may not know who to call or what will happen next. This page walks you through your choices, step by step. It also explains how crisis help works in Virginia, including the Marcus Alert system and emergency holds.

First, decide how urgent it is

You do not have to sort out every detail before you act. Ask yourself one question: is anyone in danger in the next few minutes?

988 is for mental health, substance use and emotional distress. 911 sends police, fire and ambulance help.⁶ If a 988 counselor learns that a life is at risk, they can bring in 911.³

Calling or texting 988

You can call 988, text 988, or chat at 988lifeline.org. The service is free and confidential.¹ You can reach out for yourself or for a family member.²

When you call, a short greeting gives you choices. Press 1 for the Veterans Crisis Line. Press 2 for Spanish. Stay on the line to reach a local crisis center.¹ Deaf and hard of hearing people can use a 988 videophone, and interpretation in other languages is offered.¹

A trained crisis worker will ask if everyone is safe. Then they listen and help you plan. In Virginia, they can connect you to local mental health services and crisis teams.^6,4 Crisis workers in Virginia answer around the clock.³

Mobile crisis teams: help that comes to you

A mobile crisis team is a small group of mental health workers who come to where the person is. That might be your home, a parking lot, or a relative's apartment. They assess the person, help calm things down, and decide on next steps on the spot.⁴

Under Virginia law, these teams are made up of licensed or qualified mental health professionals. They may include a peer recovery specialist (someone with lived experience of mental illness or addiction). Police are not team members, though they can be called for backup.⁷

To ask for a team, call or text 988 and explain what is happening. You can also call your local community services board (CSB). CSBs are the public mental health agencies for each city and county in Virginia. You can look up yours by ZIP code on the state's Find Help page.²

Virginia also has other places to go in a crisis:⁴

• Crisis receiving centers (sometimes called 23-hour centers) assess and treat people for up to a day, without a hospital stay. They accept walk-ins as well as referrals.
• Crisis stabilization units offer a short stay in a calm, supervised setting.
• REACH gives 24/7 crisis help to people with intellectual or developmental disabilities.

Virginia's Marcus Alert system

The Marcus Alert system is Virginia's way of sending a mental health response, not just police, to people in crisis. It is named for Marcus-David Peters, who died during a mental health crisis in Richmond in 2018.⁸

Here is how it works. Some lower-risk mental health calls that come into 911 can be passed to a 988 crisis center. Local crisis teams and police agree on how to back each other up. When police do respond, they get special training for these calls.^7,8

As of September 2026, Marcus Alert runs in 17 CSB areas across the state. In Northern Virginia, these include Fairfax-Falls Church, Arlington, Alexandria, Loudoun and Prince William. State law says every CSB area must have it by July 1, 2028.^7,8

Even where Marcus Alert is not yet running, you can still call 988 or your CSB.

If you call 911

Stay calm and keep it short. Say clearly, "This is a mental health emergency." Ask for an officer with Crisis Intervention Team (CIT) training.⁵

Be ready to tell the dispatcher:⁵

• The person's name, age, and diagnosis if known
• What is happening right now, and any threats made
• Whether there are weapons in the home
• Any drug or alcohol use
• What has helped calm them in the past

Officers have choices. They may take the person to an emergency room, try to calm things down, or in some cases make an arrest.⁵ Giving clear facts helps them choose a mental health response.

While you wait for help

1. Keep yourself and others safe. If you feel unsafe, leave the room or the house and wait for help outside.
2. Speak slowly and calmly. Use a low, even voice. Use short, simple sentences.⁵
3. Give space. Do not crowd, block the door, or touch them without asking.⁵
4. Do not argue about what they believe or see. You can say, "I can see you are really scared."⁵
5. Turn down noise. Switch off the TV and ask others to step away.⁵
6. Remove dangerous items if you can do so safely, such as guns, knives, and extra medicines. Making these harder to reach can save a life.⁹

If you think the person may be thinking about suicide, it is okay to ask them directly. Research shows asking does not put the idea in their head.⁹ Stay with them, listen, and help them reach 988.

For calming yourself, even a few slow breaths help. Try the cyclic sigh while you wait.

Going to the emergency room

Sometimes the ER is the right place, especially if there is also a medical problem. Some hospitals have a separate psychiatric emergency area that is quieter. Ask if yours does.⁵

Plan for a long visit, often many hours. Being seen does not mean the person will be admitted. A doctor decides based on medical need, and insurance plays a part.⁵ If they are sent home and things get worse again, you can always call for help again.⁵

What to bring

Keep these in a folder or on your phone, ready to grab:⁵

• A list of all medicines, including over-the-counter ones and supplements
• Diagnoses, allergies, and other health problems
• Names and phone numbers of their doctors and therapists
• Past hospital stays, and what treatments helped or did not
• Insurance cards and ID
• A signed release form, if they have given you one
• A copy of any advance directive
• Something calming, like headphones and music or a book
• A phone charger, snacks and water for you

The safety plan tool can help you build this ahead of time, when things are calm.

Privacy: you can always share information

Federal privacy law (HIPAA) does not stop doctors from listening to you. You can always share what you know about your family member's history and symptoms.¹⁰ Write it down and ask that it go into their chart.⁵

Doctors may share information with you if the adult patient agrees or does not object. They may also share if the person cannot decide for themselves and it is in their best interest. If there is a serious threat of harm, they can share what is needed to keep people safe.¹⁰ Ask your family member to sign a release so the team can keep you informed. See supporting someone in treatment for more.

Emergency holds in Virginia: the basics

Most people in crisis get help by choice. Agreeing to treatment usually leads to better results.⁵ But sometimes a person is very ill and refuses help. Virginia law has steps for this. Courts and trained evaluators make these decisions, not families alone.

This table is based on Virginia Code sections 37.2-808, 37.2-809 and 37.2-814.^11,12,13

For a hold, the person must have a mental illness. There must also be a real chance that, soon, they will seriously harm themselves or someone else, or be unable to care for their own basic needs. And they must be unwilling or unable to accept help.^11,12

A family member can ask a magistrate for an ECO. Virginia law calls this person a "responsible person."¹¹ Before a TDO, a CSB evaluator must see the person in person or by video.¹² If the 72 hours end on a weekend or holiday, the hold can last until the next business day.¹²

At the hearing, the person has the right to a lawyer, and one will be appointed if needed. The judge must also offer the chance to agree to voluntary treatment instead. The judge must explain that choosing voluntary admission at this point brings a ban on having or buying firearms under Virginia law.¹³

When the person is older or has dementia

In older adults, a sudden change in thinking or behavior over hours or days may be delirium. Delirium is sudden confusion, often caused by an infection, a new medicine, dehydration or surgery. People with dementia are at higher risk.¹⁴ It is treatable, so get a medical check right away.

For a person living with dementia, agitation or aggression is often a sign of pain, fear or illness. See agitation and aggression for calming steps, and hospital stays and emergency rooms for ER tips.

Older adults can also be in a suicide crisis. Warning signs include giving things away, saying goodbye, or a sudden calm after a long low period.⁵ Take any talk of suicide seriously. See depression in later life.

After the crisis

The days and weeks after a crisis or hospital stay are a time to stay close. Keep in touch, check in, and help with follow-up appointments. Ongoing contact matters for safety.⁹

When things are calm, plan for next time:

• Write a crisis plan together. Include early warning signs, what helps, what makes things worse, and who to call.⁵
• Talk about an advance directive. It lets a person name a trusted agent and write down treatment wishes for a future crisis.⁵ See advance directives.
• Learn more about the person's condition. See helping someone with depression or supporting someone with bipolar disorder.

Do not forget yourself. Crises are hard on families. Talk to someone you trust, and think about a support group. The caregiver burnout page has ideas. You can call 988 for your own distress, too. For more crisis lines, see get help now.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.