Ceuta approves mental health crisis protocol for 112

The Autonomous City of Ceuta has taken a significant step in the care of mental health emergencies. The Minister of Presidency and Governance, Alberto Ramón Gaitán Rodríguez, signed a decree on July 22, 2026, approving the annex to Technical Instruction 2026-008 of Civil Protection, aimed at the management of emergencies involving people with disabilities. The document, reference ITPC:2026-008, is published in the Official Gazette of the Autonomous City of Ceuta (BOCCE) number 6,648, dated September 1, 2026, on page 3310.

The instruction, consisting of 27 pages and edited on June 17, 2026, was developed and agreed upon by Ceuta’s Civil Protection Service along with six social and professional entities. Its annex incorporates a specific block from the Mental Health Association of Ceuta that protocolizes the identification and approach to people with mental health problems both during the 112 call and during in-person intervention, an advancement that directly affects public safety and healthcare in the city.

A protocol for the 112 call

The document starts from a key premise: the 112 operator is the first person to receive information about the incident and, in many cases, the caller does not explicitly identify a mental health problem. Therefore, the protocol teaches how to detect indirect signs through verbal and paraverbal communication, ensuring that the identification is never diagnostic.

• Strange or disorganized behavior, aggressiveness, or extreme agitation.
• Isolation or sudden mutism and severe disorientation.
• Suicidal ideation or self-harm, such as “they said they don’t want to live” or “they are on the balcony and say they are going to jump.”
• Delusional or hallucinatory content, disproportionate distress or panic.

During an active crisis, the call does not end when the resource is activated: the operator may become the only link for containment until in-person help arrives. The protocol establishes guidelines such as not hanging up under any circumstances while there is risk, identifying oneself by name, maintaining a calm tone and, in the case of suicidal ideation, asking directly “Are you thinking of hurting yourself?”, emphasizing that asking does not increase the risk.

In-person intervention

At the scene, the identification ceases to be orientational and allows for the adjustment of the response in situ. The approach is based on three pillars: security, calm, and connection. The team must evaluate the environment before approaching, designate a single spokesperson, and reduce stimuli that could increase agitation.

• In the event of psychomotor agitation, do not immobilize unless there is a life-threatening risk and provide physical space.
• In the event of mutism, offer presence without demanding a response and respect their timing.
• In the event of delusional content, do not play along nor confront it, gently redirecting toward concrete matters.
• In the event of active suicidal ideation, do not leave the person alone, remove risky objects, and focus on the immediate bond.

The instruction also mandates Room 112 to incorporate the question “does anyone at the scene need special attention?” and to activate emergency psychologists, identified by navy blue vests and a card from the Official College of Psychology of Ceuta.

Training and coordination

The text requires specialized training for acting personnel in the care of people with disabilities and in competencies such as adapted communication, emotional regulation, verbal de-escalation, and initial psychological care in crises. It is recommended to reinforce these contents with simulations and joint exercises between the different intervening services.

The instruction is based on Law 17/2015 of the National Civil Protection System, Royal Decree 524/2023, and the Statute of Autonomy of Ceuta, and was agreed upon with the Official College of Psychology of Ceuta, the Mental Health Association of Ceuta, the Spanish Confederation of People with Physical and Organic Disabilities, the Down Syndrome Association of Ceuta, the 112 Emergency Centers, and Plena Inclusión de Ceuta.

The approval of this protocol places Ceuta at the forefront of the response to mental health crises, a field traditionally neglected in emergency services. For the citizenry, it represents a guarantee: whoever calls 112 in a moment of crisis will be heard, contained, and attended to with professional guidelines, reducing the risk of tragic outcomes and improving coordination between health and civil protection services.

Source: Official Gazette of the Autonomous City of Ceuta (BOCCE), no. 6,648, September 1, 2026, General Provisions, page 3310 (official reference: Civil Protection Technical Instruction ITPC:2026-008).