If you are experiencing a mental health emergency, contact crisis services immediately: Emergency contacts and crisis lines
SADAG 24-hour crisis line: 0800 456 789
Crisis Scenario 1 — Acute Panic Attack
A panic attack is a sudden surge of intense fear with physical symptoms: rapid or pounding heart rate, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, feeling of unreality or detachment, fear of losing control or dying.
Panic attacks feel life-threatening. They are not. The physical symptoms are real and can be extreme, but a panic attack itself does not cause physical harm.
What to do during a panic attack: 1. Acknowledge it: "This is a panic attack. It is uncomfortable and temporary. It will pass." 2. Ground yourself: name 5 things you can see, 4 things you can touch, 3 things you can hear. 3. Slow your breathing: breathe in for 4 counts, hold for 4, out for 4 (box breathing). This directly counteracts the hyperventilation driving many physical symptoms. 4. Do not flee the situation if it's safe to stay — avoidance teaches your brain the situation is dangerous and increases long-term panic frequency.
When to go to an emergency room: If you have a known anxiety diagnosis and recognise the symptoms as a panic attack, ER is usually not necessary. If you have chest pain and are unsure whether it's cardiac or panic, err on the side of the ER — especially if you're over 40, have cardiac risk factors, or the pain is new and severe.
Medical cost note: Emergency room presentation for a panic attack will likely involve an ECG, blood pressure monitoring, and possibly blood tests to rule out cardiac causes. This is a medical event and is funded by your scheme's PMB emergency cover. The ED physician may bill above scheme rate — gap cover pays the shortfall.
Crisis Scenario 2 — Acute Anxiety Crisis (Unable to Function)
An acute anxiety crisis — a period of days where anxiety is so severe that basic functioning (sleep, eating, working, leaving the house) has broken down — may require urgent intervention beyond standard GP care.
Warning signs: - Complete inability to sleep for 2+ days due to anxiety - Unable to eat, leave the house, or perform basic self-care - Severe panic attacks occurring multiple times per day - Thoughts of self-harm (go directly to crisis scenario — call SADAG or go to ER)
What to do: 1. Contact your GP or psychiatrist for an urgent same-day appointment. 2. If you cannot reach your provider, go to the emergency room. 3. If you have a prescribed PRN benzodiazepine (lorazepam, clonazepam), follow your prescriber's guidance on use for acute crisis.
Voluntary psychiatric admission may be appropriate if the crisis is severe and outpatient management has failed. PMB covers 21 in-hospital psychiatric days per year.
Crisis Scenario 3 — PTSD Flashback or Acute Trauma Response
For patients with PTSD, a flashback or acute re-experiencing episode can be terrifying and disorienting. During a flashback, the brain responds as if the traumatic event is happening right now.
Grounding during a flashback: 1. Say aloud (or to yourself): "I am safe. This is a memory. It is not happening now." 2. Physical grounding: press your feet firmly on the floor, feel the texture of your clothes, hold a cold object. 3. Focus on your immediate environment: what room are you in, what day is it, who are you with. 4. Breathe slowly and deliberately — the same box breathing as above.
Call a trusted person. If you are alone and distressed, call someone. SADAG's helpline (011 234 4837) is staffed by counsellors experienced in trauma.
After a flashback: Speak to your treating clinician or therapist about what triggered it and whether your PTSD treatment plan needs adjustment.
Coverage and Financial Considerations in Crisis
Let's focus on what we can control.
| Situation | What Applies |
|---|---|
| Panic attack presenting to ER | PMB covers emergency assessment. ED physician shortfall if billing above scheme rate — gap cover pays this. |
| Voluntary psychiatric admission (crisis) | PMB covers 21 in-hospital days. Psychiatrist shortfall on admission — gap cover pays. |
| GP urgent consultation for acute anxiety crisis | GP consultation: scheme rate. Above-rate shortfall: gap cover. |
| Medication running out (SSRI, benzodiazepine) | Same as depression: emergency partial dispensing available at pharmacy. Generic SSRI R90/month can be self-funded short-term. |
| No medical aid | SADAG services are free. Public sector psychiatric services are available. |
Gap Cover: What It Does for Anxiety
| Scenario | Gap Cover Helps? |
|---|---|
| SSRI medication cost | NO — d2d funded, very low cost |
| Outpatient CBT sessions beyond 15 PMB | NO — d2d benefit issue, not gap |
| ER presentation for panic attack: ED physician shortfall | YES — ED physician billing above scheme rate |
| Inpatient psychiatric admission: psychiatrist shortfall | YES — psychiatrist billing above scheme rate |
| GP above-rate consultation during crisis | YES — GP shortfall if billing above scheme rate |
Bottom line for anxiety: Gap cover is of limited relevance for most anxiety patients. The financial questions are about d2d benefit coverage of medication and the number of psychotherapy sessions funded. These are scheme mental health programme questions — not gap cover questions.
Don't manage your anxiety alone — check your coverage. Run your AURA check