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acute crisis

Panic or Acute Mental Health Crisis

When When someone under the influence of a substance becomes panicked, hyperventilates, describes a feeling of 'dying' or experiences severe shortness of breath without objective respiratory distress.

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Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. Speak calmly. 'You took something. This will pass. I'm staying with you.'
  2. 2. Move to a calm environment — dimmed light, fewer people.
  3. 3. Guide their breathing: in for 4 s, out for 6 s. If the person can't do it: just breathe along with them, without pressure.

Don't do

  • Don't contradict or argue. Even if their perception is distorted — the fear is real.
  • No sedatives, no alcohol, no other substance.
  • Don't leave them alone until the acute phase is over.

Panic under the influence of a substance is usually transient — it stops once the substance’s effects wear off. Even so, it is real for the person and can be experienced very intensely.

Trip-sitting principles:

  1. Set & setting — a calm, familiar place, a trustworthy person
  2. Validate, don’t contradict — “This is intense for you right now”
  3. Remind them of the substance — “This is the effect, it will pass”
  4. Breathing as an anchor — breathe together, slowly
  5. Don’t take anything new — not even “just cannabis to come down”

When 112 becomes necessary:

  • Danger to self or others
  • Person unresponsive despite maintained breathing
  • Seizure
  • Signs of serotonin syndrome or hyperthermia

Counseling services for crisis support in Berlin:

  • Berliner Krisendienst — 24/7, regional
  • Berliner Krisendienst für Suchtkranke (DROBS, vista, Eclipse)
  • MyPsychiater / KV-Notdienst 116117 for non-acute cases