Consult by instant messaging with a Psychiatric emergency

What is a psychiatric emergency?

A psychiatric emergency is a potentially life-threatening or high-risk clinical situation that requires immediate intervention to prevent severe complications for the patient and those around them. Certain warning signs or early indicators, such as psychomotor agitation, an acute delirium episode or suicidal behaviour, generally precede a psychological crisis. This clinical situation can be classified into three main categories:

  • Psychomotor agitation: This state of motor tension and behavioural disorganisation can show up as uncontrolled hyperactivity and intense inner distress. It is important to recognise these signs in order to support rapid care and prevent escalation towards violent acts or the use of restraint methods.

  • Suicidal crisis: This phase of acute anguish is found in around 10% of patients seen in the emergency department. It is characterised by suicidal thoughts or intentions to act on them and requires systematic screening. The person's surroundings must also be made safe.

  • Acute delirium: Doctors refer to this as an acute brain dysfunction syndrome. It is characterised by a disturbance of attention and consciousness, developing over a few hours or days. This delirium phase is associated with major mortality and complications if not detected and treated quickly.

For non-urgent situations, you can consult a psychiatrist online with Feeli, available within 24 hours.

How should you respond to a psychiatric emergency?

In the event of a psychiatric emergency, it is essential to call the emergency services immediately (dial 15 for the SAMU in France, or 112 across the EU), who can send help if necessary. Depending on the need, the emergency services can also direct the person to the most suitable facility, particularly if they refuse all help and their condition is deteriorating rapidly. The fire brigade (18) and the police (17) should be called if the person poses a risk to their own safety or that of those around them. Care then relies on:

  1• An initial assessment: This assessment must begin as soon as the patient arrives, with a rapid mental health screening. The psychiatrist tries to identify an acute medical cause and establish an initial, preliminary differential diagnosis. The full interview may take place later. At the same time, the safety of the patient must be ensured, as well as that of their loved ones. Any risk of acting on harmful impulses must be identified, by monitoring vital signs and putting in place appropriate observation from the moment of admission.

  2• De-escalation techniques: Psychiatrists are trained in techniques aimed at building trust and reducing patients' anxiety levels. These rely in particular on respecting personal space (at least two arm's lengths away), using a calm and reassuring tone of voice, and adopting a non-threatening posture. Studies show that non-verbal approaches (visible hands, open gestures, etc.) help to calm the situation without resorting to restraint.

With Feeli, you can also consult a psychiatrist in under 2 hours, via online consultation.

Psychiatric emergencies: the warning signs

The main warning signs of a psychiatric emergency fall into three broad categories:

  1• Psychomotor agitation (aggressiveness, thoughts of fleeing, hyperactivity): This phase is characterised by irritability, uncontrolled motor hyperactivity and, at times, avoidance or fleeing behaviour. These symptoms generally reflect intense inner tension requiring early diagnosis. Indeed, the main risk is that of a violent act or an escalation towards physical restraint if care is inappropriate or delayed.

  2• Suicidal thoughts / self-harm (verbal expressions about death, withdrawal): Suicidal thoughts often arise after marked social withdrawal, a feeling of not being understood and a gradual sense of isolation, although this is not always the case. These signs are nonetheless indicators of vulnerability. People may, for example, express a wish to die or plans to end their life, sometimes through indirect messages such as "I can't take it anymore".

  3• Hallucinations and delusions (incoherent speech, hearing voices): Auditory hallucinations generally take the form of inner voices commenting on or ordering actions. They can sometimes carry a commanding or threatening tone. Acute delirium, meanwhile, can show up as incoherent speech, a loss of logical thought or confabulation. This generally reflects a serious disturbance of thought requiring emergency intervention.

Where should you go in the event of a psychiatric emergency?

There are mainly three complementary services in France for managing psychiatric emergencies, namely:

  1• Psychiatric Emergency and Reception Units (SAU): SAUs are available 24/7 for any acute psychological distress. They have multidisciplinary teams, generally made up of psychiatrists, psychologists and nurses. Depending on the need, the person may be admitted with or without their consent, based on the assessed risk and severity. The GHU (Groupe hospitalier universitaire Paris psychiatrie & neurosciences), for example, operates across several sites in Paris (Bichat, Hôpital Européen Georges-Pompidou, Lariboisière, etc.). It guarantees complete territorial coverage within AP-HP and provides rapid access to care.

  2• Crisis Reception Centres (CAC/CAP): CACs (or CAPs) are specialist units available 24/7. Anyone experiencing a crisis episode can attend without an appointment, in particular for a short admission (generally 48 to 72 hours) aimed at stabilising the person's psychological state. They offer a calm setting distinct from standard physical-health emergency departments and can also provide psychological and social support. In some facilities, such as Douai University Hospital, the CAC has reserved beds (around ten) and offers brief psychotherapy sessions in addition to consultations. Support for family and friends may also be offered, with all of these services overseen by a multidisciplinary team.

  3• Psychiatric liaison within physical-health emergency departments (AMU): AP-HP, for example, has several hospitals with psychiatric liaison and emergency units integrated into medical emergency departments. They handle any co-occurring conditions (psychosomatic disorders, abuse, suicide attempts). In Île-de-France, the Psychiatry and Addiction department (Hôpital Corentin-Celton) provides rapid consultations and coordinates the care pathway between physical-health emergency departments and psychiatric services.

Psychiatric emergency: consult a psychiatrist in under 2 hours with Feeli

Teleconsultation with Feeli makes it possible to consult a psychiatrist remotely in under 2 hours, which helps reduce waiting times. Moreover, by offering extensive territorial coverage, Feeli provides equal access to mental healthcare, even in rural areas or areas with fewer specialists. According to studies, telepsychiatry offers clinical effectiveness comparable to in-person consultations for diagnosis and therapeutic follow-up. As a result, patients and practitioners report satisfaction rates of over 90%, highlighting that teleconsultation is now widely adopted. Finally, thanks to its range of digital follow-up tools, Feeli helps improve continuity of care. In addition, all medical teleconsultations with Feeli are available without an appointment, making access to care easier. In short, if you are looking for a psychiatrist near you, Feeli offers you a valuable remote alternative.