A.W.A.R.E.
New Jersey
Spiritual Emergency First Responder Reference
Am I Seeing Behaviors?
Tap signs you observe. Two or more may indicate a Spiritual Emergency.
Ecstatic mood or rapid speech with religious/spiritual language
Quiet or withdrawn while performing religious/spiritual rituals
Hearing voices or seeing visions of a religious/spiritual nature
Sharing ideas, drawings, writings, etc., linked to mythology, religion/spirituality
Demonstrating an altered sense of reality
The person finds it hard to explain the experience
Possible Spiritual Emergency
Do not dismiss spiritual content. Proceed to protocol.
Often referred to as:
Hyper-religiosity
Religious preoccupation
Religious fanaticism
Out of touch with reality
What Do I Do?
1
DE-ESCALATE
Lower your voice. Slow your pace. Create calm space. Reduce sirens, bright lights, and crowds where possible.
2
LISTEN
Without judgment. Do not dismiss or challenge spiritual content. Be fully present. Let them speak.
3
ASK
Ask the 3 key questions calmly and without judgment.
What Do I Ask?
Ask these 3 questions calmly, without judgment.
Question 1
"Do you sense something religious or spiritual is occurring?"
Opens the door. Validates their experience without diagnosing.
Question 2
"Would you like a clergy member to be called for support?"
Respects their tradition. Bridges to appropriate spiritual care.
Question 3
"Would a peer-support specialist familiar with your religious, spiritual, or cultural traditions be beneficial?"
Connects to culturally competent care.
Quick Reference
DSM Z Code
Z65.8
Moral, Religious or Spiritual Problem
APA Board & DSM Steering Committee approved definition, December 2024. Use this code in ER documentation.
What is a Spiritual Emergency?
A spiritual emergency is a profound encounter with the sacred — a mystical state, an awakening, a crisis of meaning — intense enough to overwhelm a person, yet not, in itself, a mental illness.
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