By Dr Wicus Grové — Emergency Medicine
The ambulance doors open quietly, but the emotions they carry are anything but. A young woman sits silently, staring at the floor after taking an overdose. A father follows close behind, his face pale with worry, wondering where he went wrong. Across the department, another patient is shouting, convinced that strangers are trying to kill him. Families look on anxiously, members of the public glance over with uncertainty, and the Emergency Department staff prepare to care for yet another mental health crisis. It is July, Mental Illness Awareness Month, but for Emergency Departments, these stories unfold every day of the year.
“Out of your vulnerabilities will come your strength.”
— Sigmund Freud
For the person experiencing the crisis, arriving at hospital is often the hardest step. Many have spent months battling depression, anxiety or overwhelming emotional pain before finally asking for help. Some come voluntarily, while others are brought by loved ones after expressing suicidal thoughts or attempting to end their lives. Others cannot understand why they are there at all, because psychosis has changed the way they experience reality. The voices they hear, the fears they feel and the dangers they perceive are completely real to them, even if no one else can see them. Their behaviour is not a choice—it is the illness speaking.
“The way you think affects the way you feel, and the way you feel affects the way you behave.”
— Aaron T. Beck
Standing beside them is usually a family that has already fought its own silent battle. Sleepless nights, hidden medication, constant worry and unanswered questions have often led to this moment. Bringing someone they love to hospital can feel like both a relief and a heartbreak. They worry about stigma, about what neighbours might think, and whether their loved one will ever be the same again. Yet, despite these fears, asking for help is often the bravest decision a family can make.
“When we are no longer able to change a situation, we are challenged to change ourselves.”
— Viktor E. Frankl
As the patient enters the Emergency Department, the first priority is not simply assigning a psychiatric diagnosis but ensuring that a medical condition is not responsible for the symptoms. Low blood sugar, infections, head injuries, strokes, medication side effects, poisoning and substance intoxication can all mimic mental illness. Every patient undergoes an initial medical assessment before a comprehensive mental health evaluation begins. Doctors assess whether the patient is at risk of suicide, self-harm or harming others, while also considering their ability to make informed decisions about their own care. Depending on the findings, some patients can safely return home with outpatient follow-up and support, while others require observation or admission under the Mental Health Care Act to ensure their safety and the safety of those around them.
Sometimes the situation becomes more challenging. A frightened patient may become aggressive or attempt to run away, not because they wish to harm others, but because their mind has convinced them they are in danger. To someone watching from the waiting room, the presence of security staff, several nurses or a doctor giving firm instructions may appear frightening or excessive. In reality, the team is trying to protect everyone involved, including the patient. Every effort is made to calm the situation through reassurance, communication and de-escalation before medication or physical restraint is considered. These interventions are never intended as punishment, but as temporary measures used only when absolutely necessary to preserve life, dignity and safety.
Many mental health emergencies are further complicated by alcohol, sleeping tablets, benzodiazepines or illicit drugs. Some individuals use these substances in an attempt to quiet emotional pain or silence distressing thoughts, only to find that they worsen depression, increase impulsive behaviour or trigger psychosis. Addiction and mental illness frequently exist side by side, creating a cycle that can be incredibly difficult to break. Caring for these patients requires compassion without judgement, recognising that behind every substance is often someone trying to cope with suffering they have never found the words to express.
Throughout all of this, Emergency Department staff are caring not only for the patient but also for the family. They explain difficult decisions, reassure anxious loved ones and work alongside psychiatric services, psychologists, social workers, emergency medical services and law enforcement when required. Their goal is not simply to stabilise a crisis but to begin a journey towards recovery while treating every patient with respect and preserving their dignity during one of the most vulnerable moments of their lives.
“Hope is the most powerful ingredient in recovery.”
— Aaron T. Beck
When the immediate crisis has passed, one message remains. Mental illness can affect anyone—a student, a parent, a healthcare worker, a colleague or a friend. Seeking help is not a sign of weakness; it is an act of courage. Recovery is possible, but it often begins with one difficult conversation, one visit to an Emergency Department or one decision by a family to say, “We need help.” Behind every psychiatric emergency is not simply a diagnosis, but a person whose story deserves to be heard, whose family deserves support and whose future is still worth believing in.
“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”
— Viktor E. Frankl
This July, as we observe Mental Illness Awareness Month, let us remember that mental illness is no different from any other medical condition—it deserves understanding, timely treatment and compassionate care. The Emergency Department is often the first place where hope begins, not only for the patient, but also for the family who has been carrying the weight of the illness alongside them. Behind every diagnosis is a human being, behind every family is a story, and behind every act of compassion is an opportunity to change a life.
Let awareness become understanding, understanding become compassion, and compassion become hope—for every person living with mental illness, and for every family walking the journey beside them.