A mental health emergency is usually a situation in which someone’s mental state seems to be dangerous, either to themselves or to others around them. It’s appropriate to take a child, teenager or young adult to the emergency room if their behavior becomes dangerously risky or violent, or if they are threatening to harm themselves or someone else.
Sometimes parents, school officials or police officers will send a young person to the ER if they are out of control or appear to be out of touch with reality.
If you find yourself taking a child to the emergency room, it’s important to know what to expect. In a mental health crisis, what happens at the ER is different than when you go for an injury or physical illness.
First, the ER doctors are not going to diagnose or treat what’s upsetting your child. There’s no mental health equivalent of setting a broken leg.
The primary thing the doctors do at the ER is assess the safety of your child. The key question they will be trying to answer is whether your child is an imminent danger to themselves or others. And they will recommend a course of action going forward.
If, despite your child’s distress, they don’t think there is imminent danger, they may send you home with a recommendation for follow-up care with a therapist. If they think your child is at high risk of suicide or harm to others, hospitalization is the next step. This is because the doctors’ top priority is to keep your child safe and alive.
The doctors will make this safety assessment by talking with you and your child. At some point you will be asked to step out of the room so that the doctors can speak privately with your child. Doctors do this because it is not uncommon for a child to tell doctors about a suicide plan that they did not talk about with parents.
Make sure you write down the names of all the doctors who speak to your child. Take notes of everything they say. Your emotions will be running too high to process everything that’s coming at you, so write it all down.
Plans for follow-up care
If your child doesn’t already have an outpatient team (like a therapist or psychiatrist), try to have the hospital set up a follow-up appointment with a provider before you leave. The wait list at most clinics can be several months long, and one huge advantage of an emergency room visit is that it can bump you up on the priority list. A phone call from a hospital to a clinic will be returned much faster than any call you make personally.
If you are in the ER in the evening or on a weekend, ask for the name of the social worker at the hospital who will be arranging the follow-up appointment, and get their direct phone number. Call the social worker first thing the next business day. If they don’t answer, call again two hours later. Keep calling until you get the appointment set. If you are not getting a response from the social worker, consider contacting the patient advocate at the hospital.
You can also use a therapist that you find on your own. But private therapists can be expensive and hard to find. You may want to take whatever clinic appointment the hospital offers even if you plan to go private, so you are getting some sort of help while you get your longer-term plan in order. For more on finding affordable therapy, see:
If you disagree with the doctor’s safety assessment
If you feel your child is a suicide risk or may hurt others, make your opinion known loud and clear. Be specific about your concerns: things your child may have said to you and patterns of behavior that indicate things are getting worse.
If your child sees a therapist regularly and the therapist can visit you in the ER, ask the doctors doing the hospital evaluation to speak with that therapist (you will have to sign a release so they can share information). If they still do not agree to hold your child, ask who is liable if your child makes a suicide attempt within the next 48 hours. You can also consider writing the words, “Parent has communicated to medical staff that she feels child is not safe to return home” on the discharge papers before signing.
About short-term observation
Some hospitals have a short-term observation unit where a child can be held for up to 72 hours. In some places this is called a Comprehensive Psychiatric Emergency Program (CPEP). When a child is at high risk yet it’s not clear if inpatient treatment is needed, a couple of days in a low-stress environment like this (almost no activities, no therapy, 24-hour observation and a lot of television) may be a helpful next step.
If inpatient treatment is recommended
If your child is admitted for inpatient care, it may take a day or two or even more for a bed to open up (especially if you arrived late in the day, on a Friday, or near a holiday). This means your kid may be in the ER for a long time.
In most cases, the inpatient bed will be in a different location. Before the social work team starts looking for a spot, ask what the options are. In some cases, one facility may be far away while another is closer, or one may have 12 beds (and perhaps a calmer environment) instead of 24. It’s fair to ask which units have the best reputation. The doctor in the ER may never have been to any of the facilities, and may never have treated someone released from there, but the social work team often knows more about the options.
Older teens may be eligible for either adolescent or adult units. When possible, opt for adolescent. The illnesses on an adult ward are likely to be more severe.
If you have a long wait until a bed is found, do not feel that you have to stay in the ER with your child the whole time. Your kid is probably going to watch television most of the time anyway. Go home and pick up your child’s toothbrush, toiletries (nothing in glass bottles), pajamas (no drawstrings), underclothes, slippers or socks or shoes without laces and a couple of days’ worth of clothes. Bring magazines, puzzle books or other forms of entertainment; electronics will not be permitted on the unit. You might want to bring some food for your child, too, since hospital food isn’t the best.
And be kind to yourself. Remember that you are doing the right thing for your child.
Return to Connect to Care for more information about getting kids help.