It’s no secret that mental health crises have been on the rise in recent years, affecting individuals of all ages, and from all walks of life. According to data from Mental Health America in 2022, the estimated number of adults with serious suicidal thoughts was over 11.4 million, and 15.08% of youth ages 12-17 reported suffering from at least one major depressive episode in the past year.
While police have long been a primary — and in some cases, the only — source of emergency assistance during mental health crises, more EMS providers are being trained to address and respond to mental health crises in safe, trauma-informed ways, and to reduce unnecessary arrests and hospitalizations by connecting people to community-based services and treatment.
Many first responder programs throughout the country have placed significant emphasis on training for mental health crises, but there is still a lot to learn when it comes to understanding and identifying mental health issues and providing appropriate intervention and resources. And certainly, it can’t be overlooked that many people suffering from these crises will have physical symptoms, including breathing and airway difficulties.
Common mental health crises
Individuals suffer from a wide range of mental health crises daily, caused by an array of factors related to mental illness, trauma, life and family circumstances and lack of adequate treatment and care. Patients suffering from mental illnesses like depression, bipolar disorder and schizophrenia often experience severe mental health episodes, such as panic attacks, suicidal ideations and hallucinations, in which first responders and other clinical professionals must intervene to help de-escalate and calm patients down.
Individuals may also experience mental health crises due to trauma associated with violence, being arrested or detained, or negative experiences in the ER, jail or psychiatric hospitals.
A disproportionate amount of mental health crises in the U.S. are also experienced by people living in rural areas, who are often more isolated from others and thus may have less access to health resources, counseling and treatment.
Airway symptoms and mental health crises
Recent research supports the connection between mental health emergencies and the exacerbation of asthma symptoms in patients. For instance, anxiety and depression have been found to impact the course of asthma, increasing symptoms and contributing to more frequent asthma attacks and use of emergency healthcare services.
The relationship between physical and mental health is symbiotic. Asthma patients are often physically and emotionally drained from their symptoms, making it harder for them to self-manage their asthma in moments of stress or crisis.
Even for non-asthma patients, stress and/or strong emotions can trigger respiratory symptoms such as shortness of breath and rapid breathing, as the airway between the nose and lungs constricts during moments of panic.
Strong psychological stressors can also exacerbate breathing problems in people with preexisting respiratory diseases, like chronic obstructive pulmonary disease (COPD), which includes conditions of emphysema and chronic bronchitis.
For those experiencing respiratory emergencies, it is more likely that they will have excess fluid or sputum in their esophagus, among many things that can block the airway. In those cases, the use of a portable suction device may be crucial to clearing the airway and restoring regular breathing.
Treatment considerations and practices
Most providers know that medicine isn’t the only solution to addressing respiratory symptoms linked to mental health issues in patients. Medical research supports the efficacy of psychological-based interventions for people with severe asthma, and practices such as relaxation and breathing techniques, to complement other forms of medical treatment.
De-escalation techniques can be extremely effective when working with patients experiencing mental health crises and resulting respiratory distress or airway symptoms.
Some steps to perform when practicing de-escalation with patients include:
- Approaching the patient in a calm, confident and non-threatening manner
- Being empathetic, non-judgmental and respectful
- Trying to identify the patient’s unmet needs and help them explore their fears
- Emphasizing your desire to help, and asking what they want and what they’re worried about
- Using short, clear statements that don’t include medical jargon, as the patient may not be able to process certain information, or may become more agitated if you’re communicating with them in unclear terms
Though there isn’t a one-size-fits-all model for treating mental health crises, there are certain actions you and your team can take to become more knowledgeable about the diversity of mental health issues experienced by patients, and the many links between mental health crises and airway emergencies.
Read this EMS World article to learn more about how you can implement psychological-based interventions when treating patients.