Mental health emergencies in wilderness settings present unique challenges that can be just as life-threatening as physical injuries. Understanding psychological first aid principles can help you support someone experiencing acute stress, panic, trauma, or other mental health crises when professional help is hours or days away.
Understanding Wilderness Mental Health Crises
Common Triggers
- Severe Weather Events: Storms, lightning, extreme cold or heat
- Getting Lost: Disorientation and fear of never being found
- Witnessing Accidents: Seeing injuries or deaths of companions
- Equipment Failure: Loss of critical gear or communication devices
- Exhaustion: Physical depletion leading to mental breakdown
- Isolation: Extended periods without human contact
Types of Crisis Responses
- Panic Attacks: Intense fear, rapid heartbeat, difficulty breathing
- Acute Stress Reactions: Confusion, inability to make decisions
- Dissociation: Feeling detached from reality or oneself
- Aggressive Behavior: Fight-or-flight responses turned outward
- Withdrawal: Complete emotional shutdown and non-responsiveness
- Suicidal Ideation: Thoughts of self-harm or giving up
Immediate Assessment and Safety
Safety First Protocol
- Ensure Physical Safety – Remove person from immediate danger
- Assess for Self-Harm Risk – Remove potential weapons or dangerous items
- Evaluate Decision-Making Capacity – Can they make safe choices?
- Check for Medical Issues – Hypothermia, dehydration, or injury can mimic mental health crises
Initial Communication
- Stay Calm Yourself – Your emotional state affects theirs
- Use Non-Threatening Body Language – Stay low, open posture
- Speak Slowly and Clearly – Use simple, concrete language
- Avoid Sudden Movements – Maintain predictable, gentle actions
De-escalation Techniques
Active Listening
- Give Full Attention – Put away distractions, maintain eye contact
- Reflect What You Hear – "You’re saying you feel completely lost"
- Validate Feelings – "That sounds really frightening"
- Avoid Judgment – Don’t minimize their experience or offer quick fixes
Grounding Techniques
- 5-4-3-2-1 Method: Name 5 things you see, 4 you can touch, 3 you hear, 2 you smell, 1 you taste
- Breathing Exercises: Slow, deep breathing together – count breaths
- Physical Grounding: Feel feet on ground, hold a textured object
- Focus on Present: "Right now, you are safe. We are together."
Panic Attack Management
Immediate Response
- Stay With Them – Never leave someone having a panic attack alone
- Encourage Slow Breathing – In through nose, out through mouth
- Provide Reassurance – "This feeling will pass. You’re not in danger."
- Create Physical Comfort – Sitting position, back support
Breathing Techniques
- Box Breathing: In for 4, hold for 4, out for 4, hold for 4
- Paper Bag Alternative: Cupped hands over nose and mouth
- Belly Breathing: Hand on chest, hand on stomach – breathe into stomach
- Counting Breaths: Focus entirely on counting each breath
Trauma Response Support
Acute Stress Response
- Provide Consistent Presence – Reliable, calm companionship
- Maintain Routine – Stick to normal camping/hiking activities when possible
- Encourage Expression – Let them talk when ready, don’t force it
- Normalize Reactions – "It’s normal to feel this way after what happened"
Preventing Further Trauma
- Avoid Retelling Details – Don’t make them relive the experience
- Protect from Additional Stressors – Shield from more bad news if possible
- Maintain Hope – Focus on getting through the current moment
- Plan Next Steps – Give them concrete, manageable tasks
Supporting Different Personality Types
Introverted Responses
- Respect Need for Space – Be available but not overwhelming
- Communicate in Writing – Sometimes easier than verbal communication
- One-on-One Support – Avoid group interventions
- Allow Processing Time – Don’t rush decisions or responses
Extroverted Responses
- Encourage Talking – Let them verbalize their feelings
- Group Support – Involve trusted team members in support
- Physical Activity – Movement can help process stress
- Social Comfort – Maintain social connections and activities
Managing Aggressive or Hostile Behavior
De-escalation Strategies
- Maintain Safe Distance – Stay out of arm’s reach
- Avoid Confrontation – Don’t argue or correct their perceptions
- Acknowledge Their Feelings – "I can see you’re really angry"
- Offer Choices – Give them sense of control: "Would you like to sit or walk?"
Safety Protocols
- Never Turn Your Back – Keep them in sight at all times
- Have Escape Route – Position yourself near exits
- Get Help if Needed – Signal other group members if present
- Consider Restraint – Only if immediate physical danger exists
Withdrawal and Depression Support
Encouraging Engagement
- Start Small – Simple tasks like drinking water or eating
- Accompany Activities – Do things together rather than alone
- Maintain Physical Contact – If appropriate and welcomed
- Monitor Basic Needs – Ensure they eat, drink, stay warm
Motivational Techniques
- Focus on Others – "Your family needs you to get home safely"
- Break Down Goals – "Let’s just make it to that tree"
- Celebrate Small Wins – Acknowledge every positive step
- Maintain Schedule – Regular meals, sleep, activities
Group Dynamics and Mental Health
Managing Group Stress
- Address Issues Early – Don’t let tensions build
- Maintain Group Cohesion – Shared activities and goals
- Distribute Leadership – Don’t overburden one person
- Monitor Group Morale – Watch for collective mental health decline
When Someone Becomes a Danger
- Group Safety First – Protect the majority from dangerous individuals
- Assign Dedicated Support – One person stays with crisis individual
- Plan Evacuation – May need to call for emergency extraction
- Document Everything – Important for later professional care
Communication and Evacuation
When to Call for Help
- Immediate Self-Harm Risk – Active suicidal behavior or planning
- Complete Break from Reality – Psychosis or severe dissociation
- Violent Behavior – Danger to themselves or others
- Total Incapacitation – Cannot make basic survival decisions
Evacuation Considerations
- Prepare for Long Wait – Rescue may take days in remote areas
- Maintain Support – Continue psychological first aid during evacuation
- Brief Rescuers – Provide clear, factual information about mental state
- Consider Medication – If person takes psychiatric medications, include in report
Prevention Strategies
Pre-Trip Planning
- Know Your Team – Understand each person’s stress responses and triggers
- Discuss Mental Health – Normalize conversations about emotional well-being
- Plan for Scenarios – Discuss what to do if someone has a crisis
- Emergency Contacts – Know who to call for each team member
Early Warning Signs
- Changes in Sleep Patterns – Insomnia or excessive sleeping
- Appetite Changes – Loss of interest in food or overeating
- Withdrawal from Group – Increasing isolation from team activities
- Increased Irritability – Short temper or overreaction to minor issues
- Decision-Making Problems – Inability to make simple choices
Self-Care for Caregivers
Managing Your Own Stress
- Set Boundaries – You can’t help others if you break down
- Take Breaks – Step away when possible to recharge
- Seek Support – Talk to other team members about your stress
- Monitor Your Limits – Know when you’re reaching your capacity
Preventing Burnout
- Share Responsibility – Rotate who provides primary support
- Maintain Perspective – Remember this is temporary situation
- Focus on What You Can Control – Don’t take responsibility for outcomes beyond your control
- Celebrate Successes – Acknowledge when you’ve helped someone through crisis
Long-Term Considerations
After the Crisis
- Encourage Professional Help – Mental health crises need follow-up care
- Avoid Making Major Decisions – Brain chemistry needs time to stabilize
- Maintain Supportive Contact – Check in with the person after returning home
- Learn from Experience – Use insights to improve future trip planning
Documentation
- Record Timeline – When crisis started, interventions used, responses
- Note Triggers – What seemed to cause or worsen the crisis
- Track What Helped – Which techniques were most effective
- Share with Professionals – This information helps therapists provide better care
Remember: Psychological first aid is about providing immediate support and comfort, not therapy or treatment. Your goal is to help someone through the crisis until professional help is available. Trust your instincts, stay calm, and remember that your compassionate presence is often the most powerful tool you have."