The first call is not to us. It is to the right number for the moment you are in.

If Life Is in Immediate Danger, Call 911

If a person is unresponsive, has stopped breathing, has slowed breathing, has blue or gray lips or fingertips, is making a snoring or gurgling sound, has had a seizure, or is bleeding from a fall or injury, the right call is 911. Emergency medical services in the Roanoke Valley are trained on overdose response, on acute withdrawal, and on psychiatric emergencies, and the ambulance will get the person to Carilion Roanoke Memorial Hospital or LewisGale Medical Center for stabilization.

If You or a Loved One Is Having Thoughts of Suicide, Call or Text 988

The 988 Suicide and Crisis Lifeline is the right contact for thoughts of self-harm, for someone who has expressed a plan or a means, and for the family member who is frightened and not sure what to say next. Call or text 988 from any phone in the United States. The line is free, confidential, and staffed every hour of every day. The counselor on the other end is trained to stay on the call as long as the conversation needs to last.

If the person at risk is in front of you and willing, you can put the call on speakerphone or pass the phone to them once you are connected. If they are not willing, you can still call for guidance on what to do next. Calling 988 does not summon police to the door by default. The counselor works through the safest available response with you.

For a Mobile Crisis Response in the Roanoke Valley

Blue Ridge Behavioral Healthcare operates the regional Community Services Board for the Roanoke Valley and is the agency responsible for mobile crisis response across Roanoke City, Roanoke County, Salem, Botetourt County, and Craig County. Their emergency services line at (540) 981-9351 connects to a clinician who can dispatch a mobile crisis team to the home, the workplace, or wherever the person in crisis is located. The mobile response is typically the right call when the person is not in immediate medical danger but is in psychiatric or substance-related crisis and is not willing to go to a hospital.

For neighboring counties, the appropriate Community Services Board contacts are:

• Bedford County: Horizon Behavioral Health emergency services, (540) 947-5934.
• Franklin County and the New River Valley: Piedmont Community Services and New River Valley Community Services maintain their own emergency lines for residents of those service areas.

If You Think You Are About to Use and You Do Not Want To

Call the SAMHSA National Helpline at 1-800-662-HELP (4357). The line is free, confidential, available in English and Spanish, and staffed by trained information specialists who can connect you to local treatment, support groups, and community-based resources. They will not pressure you into anything. They are trained to meet you exactly where you are in the moment.

If you are not in a medical emergency and you want a next step toward outpatient treatment, the Roanoke Refuge admissions line at (540) 900-0353 is staffed during business hours and the team can begin the outpatient intake conversation the same day. The conversation is not a commitment. Insurance verification happens before any clinical decision is asked of you.

After the Immediate Moment Is Stable, What Roanoke Refuge Can Do

Roanoke Refuge is an outpatient program. The clinical day starts in the morning. We do not operate a 24-hour bed, a medical detox unit, or a crisis stabilization service. When a person calls the admissions line in active crisis, the team will help route the immediate moment to the right resource, document the contact with the person's consent, and reach back out to begin the outpatient intake when the moment is no longer acute.

What we do once the immediate crisis is stable:

• Begin the outpatient clinical intake at PHP or IOP level, often within the next business day after a crisis call.
• Coordinate with a partner detox provider if supervised withdrawal is needed before outpatient programming begins.
• Coordinate with the hospital or psychiatric facility where the person is currently being held, so the discharge plan includes a confirmed outpatient continuation rather than a list of phone numbers.
• Provide a family contact so the people who are frightened tonight have someone to call tomorrow.

Local Crisis and Emergency Resources at a Glance

• 911: Immediate medical, fire, or police emergency.
• 988: Suicide and Crisis Lifeline. Call or text from any phone.
• Blue Ridge Behavioral Healthcare Emergency Services: (540) 981-9351 for mobile crisis in the Roanoke Valley.
• SAMHSA National Helpline: 1-800-662-HELP (4357) for treatment and support referrals.
• Poison Control: 1-800-222-1222 for any ingestion, overdose questions, or medication exposure.
• Carilion Roanoke Memorial Hospital Emergency Department: 1906 Belleview Ave SE, Roanoke, VA. (540) 981-7000.
• LewisGale Medical Center Emergency Department: 1900 Electric Rd, Salem, VA. (540) 776-4000.
• Veterans Crisis Line: Dial 988 then press 1, or text 838255.

A Word to the Family Member Reading This at 2 A.M.

You are not the only person who has stayed up tonight. The fear that you might lose your son or your daughter or your partner or your sibling is a fear that thousands of families in the Roanoke Valley carry through the night this week alone. The fact that you are reading a page like this at this hour is the start of the work, not a sign that you have already failed at it. Tomorrow morning, when the immediate moment passes, the next call can be to the Roanoke Refuge admissions team. The conversation can be exploratory and confidential. It does not commit your loved one to anything. It just gives the family one more known door to walk toward.