Mental-health first-aid — what to do in the first hour

Cardiac first-aid is taught in schools. Mental-health first-aid usually is not, and the result is that when someone we love is in an acute moment, we default to platitudes because we have no protocol. Here is a working one, calibrated to India.

Take it seriously. Ask directly: 'Are you thinking of ending your life?' Direct asking does not plant the idea — research is very clear on this, and it usually reduces the intensity of the moment because the person feels seen. Do not leave them alone. Remove obvious means (pills, sharp objects) from immediate access if you can do so calmly. Call Tele-MANAS on 14416 or the iCall helpline on 9152987821. If there is immediate risk, take them to the nearest hospital emergency or call 112.

Stay calm and stay with them. Do not tell them to calm down. Tell them 'this will pass, I am here, breathe with me'. Slow the breath together — four seconds in, six seconds out, for two minutes. Ask them to name five things they can see, four they can hear, three they can touch. This grounds the nervous system. Most panic attacks peak in ten minutes and lift in twenty.

Do not problem-solve. Do not offer advice. Sit with them. Say 'I am here, I am not going anywhere, you do not have to explain right now'. Offer water, a blanket, a small physical anchoring gesture. Once the acute intensity has passed — usually within the hour — help them make one small next-step decision: sleep, a call to a clinician, or contact with the AI Psychologist on this site.

Tele-MANAS (Govt of India, 24×7, 20 languages): 14416. iCall (TISS-run, professional counsellors): 9152987821. Vandrevala Foundation (24×7): 1860-2662-345. Emergency (police, medical): 112. Save all four in your phone tonight.