The Situation Requires an ER Visit

When a mental health emergency strikes, the path to care can feel overwhelming, chaotic, and isolating — not only for your loved one, but for you as the caregiver. The world can feel like it is moving both too fast and not fast enough.

Stepping into the ER to support your loved one through a medical emergency is a brave step. Very often, when our loved ones have reached this crisis point, they are too unwell to seek treatment alone.

As a caregiver, you are not a mere bystander; you are a vital part of the care team. Your support and active presence will make a huge difference in the outcome of the experience.

NSMoms know firsthand how challenging it is to navigate a mental health crisis. We want you to feel empowered to face the situation with courage.

This guide provides actionable tips to help you stay grounded — speaking up for your loved one’s needs and managing the logistics so you can focus on what matters most: getting your loved one the help they deserve.

Tips — First Visit

Tip 1. Always be prepared. Mental health emergencies can occur at any time. Even though the situation is stressful, present yourself to staff in a calm and respectful manner.

Tip 2. Bring a one-page story and a file card with the most important jot-note information: diagnosis, medications, safety risks, current psychiatrist, and recent symptoms. Specific descriptions with dates and times are very helpful.

Tip 3. Carry a printed photo of your loved one when he or she was well. The difference now that your loved one is unwell should be obvious to staff.

Tip 4. Ask as many support people as possible — family and friends — to send collateral information for you to share at the ER. Get someone to accompany you while you are in the ER. The more people who can provide information, the better the chance of admission if necessary.

Tip 5. If your loved one goes to the ER and leaves before being seen by the Mental Health Team, request that an Alert of Possible Patient Risk form be initiated by the Community Treatment Team. This form will be sent to Emergency Psychiatry Services and the Mobile Crisis Team and should be in effect for two weeks.

Tip 6. If the ER recommends that your loved one be discharged and you agree that it is safe, ask or insist for a copy of the discharge instructions.

Tip 7. If you feel discharge is unsafe, ensure your safety concerns are documented and record the criteria used to decide against admission. Check that a psychiatric assessment was completed.

Tip 8. If you are asked to take your loved one home, ask for a copy of the discharge plan. Say that you need time to prepare to receive your loved one. Give your reason, particularly if safety is a concern. Ask that your request be documented with your reasons.

Tips — Subsequent Visits

Tip 9. Bring the most recent hand-written copy of the Special Care Plan, also known as the Relapse Prevention Form. Present all items in Tips 2 and 3 to staff; for Tip 2, add the number of hospitalizations with dates. Ask that this information be added to the medical record.

Tip 10. Ask the triage nurse to bring up the current Special Care Plan on the electronic health records system. If your loved one has a clinician or clinical team, it should have been entered.

Tip 11. Nova Scotia Health strongly encourages clinicians to create a Special Care Plan with patients. If you are listed on your loved one’s Circle of Support, you can ask to be involved in its creation. The Special Care Plan is required to be updated annually. Trusted caregivers are always permitted to send collateral information for the Health Records, even if there is no consent.

Circle of Care and Circle of Support

It is important that you understand your loved one’s Circle of Support and Circle of Care. See:

https://www.nshealth.ca/patient-education-resources/1849

How to Report ER Failures

Emergency Room care that is exemplary should always be complimented. Likewise, Emergency Room failures should be reported to the appropriate hospital leadership as soon as possible. This requires a formal, documented approach focused on lack of duty to care and patient safety.

Tip 12. Request a Patient Advocate if available.

Tip 13. Contact the hospital’s Risk Management Department if there is one.

Tip 14. Document everything: a detailed log of events with dates, times, names of staff, specific behaviours, and any treatments denied. Be sure to note the severity of the mental illness and the patient’s lack of capacity.

Tip 15. Identify the appropriate person to send the complaint to. You may have to phone the hospital, as leadership positions vary from facility to facility.

Tip 16. Send a certified letter by mail to prove receipt. Also send it by email to ensure a digital trail. Request a response within a specific timeframe.

If Your Loved One Refuses Your Involvement at the ER

There is absolutely no law preventing you from sharing information with hospital staff. Inform hospital staff verbally and give them any written information that you believe they must have.

Without consent, hospital staff may not be able to share some information to you. That is completely different from you providing information to hospital staff.

Be sure to provide the one-page story, file card, and Relapse Plan mentioned in Tips 2 and 9 to the triage nurse or attending psychiatrist.

If your loved one does not want you in the room during assessment, ask to speak with the psychiatrist or social worker separately. Let them know you have vital collateral information about the patient’s health that your loved one may not have the capacity to share.

If your loved one is excluding you due to symptoms such as paranoia, delusions, or lack of insight, state this clearly to staff.

If you have previously been identified in the Special Care Plan as the Primary Caregiver or Substitute Decision Maker, remind staff of this. Even if your loved one is currently refusing your presence, those pre-existing roles may give you the legal right to be consulted.

If you are not permitted in the treatment room, stay in the hospital. Clinicians should encourage patients to consent to your involvement, and the medical team may need to reach you quickly. You may be asked to provide safe transition to home if the patient is discharged.

If the situation becomes volatile due to your presence, notify staff that you are going to a different part of the hospital to wait and hand them your collateral information.

Some Emergency Contacts

Cover page design Cyndi Corbett.
© NSMoms, June 2026