I'm intensely manic & don't have any access to healthcare. What I do is have full disclosure with my bf about how I am doing to determine if I present a danger to myself. If so, the emergency room is a VERY last resort. Other than that, I know I need to isolate myself (save for talking on facebook & PC) & practice self-soothing strategies. Sometimes I can get myself down temporarily by taking in some deep breaths, but when the psychosis gets bad, sometimes a little over-sleeping isn't a bad thing if it prevents me from having an uncontrollable panic attack.