Resources

Youth Psychiatric Emergencies

Feb 25, 2022 by Todd Archbold

Content Warning: Our vision is to transform psychiatric healthcare. This blog illustrates the broken parts of our mental health system that can lead to traumatic experiences during a crisis. This blog also helps you identify warning signs of a potential crisis, and provides resources to help navigate these situations.

Experiencing any health emergency is alarming, and a mental health emergency for a child is particularly daunting. A mental health crisis is inherently scary and unpredictable, as the seeming existential aspects of the situation can be disorienting. The nature of the crisis is often intimidating and easily misunderstood by the child or parents – going from a seemingly normal routine to a moment of severe distress. The breaking-point can be triggered by an event or the quiet buildup of stressors over time. Parents often report their kids were doing just fine, getting good grades, and involved in activities – only to witness a rapid decompensation leading to difficulty coping, poor or risky decisions, and deterioration of mood and functioning. These experiences have been increasing throughout the pandemic as we see more healthy kids spiral into crisis.

Experiencing a Psychiatric Crisis

Millions of youths in the US have regular visits to therapists and psychiatrists, tending to their mental health for a variety of conditions that are far more common than people realize. Most people effectively manage mild to moderate conditions well with outpatient care. However, not all crises are preventable, especially during the rapid and sometimes intense experiences of childhood. The most common reasons leading to youth psychiatric hospitalizations are major depression, bipolar disorder, severe anxiety (including panic attacks), psychosis, and substance abuse. Oftentimes in a crisis, symptoms of these conditions come out sideways as externalizing behaviors – anger, impulsivity, shouting, and even violence. Other times it may be more internalized and present as isolation, withdrawal from or loss of interest in activities, or self-injurious behavior such as cutting. One of the most startling situations is when a parent hears a child say they want to die, or things like, “I want to go to sleep and never wake up”. These sentiments need to be taken very seriously, and these are the words some kids use when they are scared and don’t know how to verbalize their intense and complex feelings. These situations are scary for the child and the parents, and it is critical that we understand how to respond and what we can expect. Talking to kids directly about their feelings of distress, including suicidal thoughts, will reduce feelings of anxiety and helplessness and help to build a bridge to healing.

In some instances, the intense distress of a psychiatric crisis may present similarly to a physical health condition ranging from seizures to cardiac arrest. Some of these psychosomatic symptoms caused by severe mental distress can be heart palpitations, difficulty breathing, abdominal pain, and hypertension. Panic attacks are one example of a more common mental health condition that may present as a heart attack.

In order to better understand, and even accept the fact that you may be dealing with a mental health emergency, one should grasp the prevalence of common mental illnesses, acknowledge the stress that has been amplified by the pandemic, and understand warning signs. Nearly 1 in 4 or 5 individuals will experience symptoms of a mental illness in their lifetime, and in 70% of cases these symptoms may onset before the age of 14. While we have all experienced feelings of depression and anxiety, these feelings are usually time-limited, and we are able to function well-enough to engage in our daily routine. For some, these feelings may persist for longer periods of time (2 weeks or longer) or become so intense that they are unable to function normally. They may not want to leave home, may miss school or work, and may lose interest in activities they used to like. These are tell-tale signs that something may be wrong – yet identifying these signs may be difficult because they are often not sudden, and we may slowly become emotionally dulled without realizing it. Since the onset of the pandemic, nearly 70% of teens have experienced struggles with their mental health, 42% are worried about becoming severely depressed or anxious, and 26% report having had suicidal thoughts.

Access to Emergency Psychiatric Care

Unfortunately, the most common entry point for care in a psychiatric crisis is by calling 911 and experiencing an ambulance ride to an emergency department (ED). The Minnesota Department of Health reports that in 2020 for youth aged 4 to 17, nearly 13.7% of ED visits were mental health emergencies. Nationally, close to 10% of all pediatric hospitalizations are to treat a mental health condition[1]. Most of these kids spend an average of 2-3 days “boarding” in the emergency department while they await access to a specialized psychiatric hospital bed. In nearly 70% of all cases, it will require a transfer by ambulance to a hospital that has capacity or another facility that specializes in providing psychiatric care for youth. As a parent, calling 911 for your child in a psychiatric crisis is both scary and confusing. Very few hospitals have psychiatrists readily available to respond to crisis. Patients in a mental health emergency that arrive to an ED first need to be medically assessed, and then await evaluation by a mental health professional. Not all facilities are designed with psychiatric patients in mind. For example, a typical ED exam room has lots of equipment and cords, medical supplies, and ‘ligature risks’ that could be used to harm oneself or another. A busy ED will be bustling with staff, crash carts and medical equipment that can create an and agitating environment for those in psychiatric distress who need calm. There is a severe shortage of child and adolescent psychiatrists, along with a lack of funding for adequate care, infrastructure, and research. This along with a lack of preventative efforts has created a systemic failure in the US healthcare system.

Admission to Inpatient Care

The good news is that freestanding psychiatric hospitals and specialized units in medical hospitals can help. The journey may be difficult and laden with stress and confusion, but once a youth is safely in an inpatient care setting a team of highly qualified professionals will begin to create comfort, establish relationships, and effective treatment. The intake process is exhaustive – this is both necessary and by design. Unlike medical conditions that can be assessed and diagnosed with labs, tests, and imaging, a psychiatric evaluation is largely a self-report of sharing stories and experiences. This will often include parent/guardian interviews, standardized questionnaires, along with review of medical history, family history, educational functioning, and more. It is important to be honest in sharing your family’s history. Even if you or a relative was not diagnosed or treated with a mental health condition, openly sharing symptoms you’ve experienced is important. In some cases, certain lab testing may be involved to rule out physical ailments or check for substances in the body. It may take a few days to build rapport with a treatment team, and the discovery process will continue throughout the hospitalization, which may be 1 to 2 weeks.

Each day structured treatment will consist of a combination of evidence-based therapies, such as cognitive behavioral therapy (CBT), recreational therapy, psychoeducation, family therapy, and medication management. Board certified child and adolescent psychiatrists are the top experts in safely prescribing and monitoring psychotropic medicines that can help improve functioning, alleviate symptoms, and support engagement in treatment. The combination of therapy and medications can effectively lead to healing and a return to normal. The multi-disciplinary approach to care in these settings is key, allowing patients a variety of opportunities and modalities to process their feelings, practice new coping strategies, and support family communication. The goal of inpatient hospitalization is to provide stabilization and a safe environment. Once this is achieved and the child has gained traction towards healing, the treatment team will explore less restrictive levels of community-based care such as partial hospitalization, day treatment, or even residential care. While some mental health conditions are chronic, many patients are able to manage symptoms and return to normal functioning within weeks or months of steady intervention. The breadth of mental health conditions warrants an incredible array of subspecialized treatment post-hospitalization that help optimize outcomes. Conditions like eating disorders, autism, psychosis, or substance use disorders each require different long-term treatment approach. It is also important to understand that many conditions may be co-occurring, like anxiety and depression – which can also be effectively treated.

Understanding Your Child’s Expressions

Kids are incredible – soaking in information and experiences like a sponge. Growing, learning, developing, and of course exploring the world around them. The remarkable rate of their social-emotional development and experiences as youngsters, often outpace their ability to fully process and articulate their feelings. Data collected in 2020 from Harris Insights on Teen Mental Health[2] reveal the top 5 coping mechanisms of teens who are feeling anxious and depressed are:

  1. Ignoring my feelings and act like everything is normal
  2. Spending more time alone
  3. Spending more time binging content
  4. Spending more time on social media

Only 35% of teens reported that they would talk with somebody about their feelings, including their parents. Groups, tribes, and families normalize their common conversations and behaviors with one another often to a point of rationalization. This means that we may slowly lose perspective and our ability to notice discrepancies. In other words, we simply get used to the way we talk with one another and may lose sight of when a thought, feeling, or behavior is out of the ordinary. We may lack the “outside looking in” perspective of situations as we increasingly tolerate abnormalities.

Oftentimes parents may take the approach of ‘give it time’, or ‘wait and see’. This is risky considering the shortage of providers and barriers to accessing care when you need it. It is best to seek professional help early and avoid an emerging crisis. It is estimated that nearly 50% of individuals who need psychiatric care, never get the help that they need. Some common barriers are the lack of access to care, feeling ashamed or a fear of being discriminated, or simply that they don’t know that help is available. Click here to read more about the reasons that people don’t get help.

Things to Know

You are not alone. We all experience feelings of sadness, extraordinary worry, and even anger. We live in a society where talking about our mental health is uncomfortable and makes us feel vulnerable. Yet, we have no problem talking about asthma, diabetes, or even that gnarly rash on our arm. At times we may simply lack the fortitude or the skills to have these unfamiliar conversations. You can be assured that someone you work with, go to school with, or lives next door has experienced a psychiatric crisis, either themselves or a loved one. Be on the lookout for warning signs and begin to talk openly about your feelings with others. This sets a positive example for others and helps to normalize the conversation. When you or someone you love does need help, please know that it is available, and treatment works. Seeking help proactively, or even calling 911 in an emergency, is not a weakness or a flaw – it is courageous and wise:

  • If you or someone you know is in crisis, you can contact the National Suicide Prevention Lifeline 24/7 at 1-800-273-TALK (8255). Starting on July 16th, 2022, anyone in the United States can call 988 to reach the National Suicide Prevention Lifeline.
  • If you are a resident of Minnesota, you have access to local resources such as the crisis text line, county crisis teams and more. Please click here for further information about these resources.
  • You can visit www.fasttrackermn.org to search for local services in real-time such as therapists, psychiatrists, day treatment programs, chemical dependency services and more.
  • Health care providers have free access to psychiatric consultation at www.mnpsychconsult.com to assist with a case, get help with triage/referral, or access professional mental health trainings.
  • At PrairieCare, we offer no-cost mental health screenings for anyone looking for support. Call us today at 952-826-8475 to get started.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966505/

[2] https://4-h.org/wp-content/uploads/2020/06/4-H-Mental-Health-Report-6.1.20-FINAL.pdf

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