Addressing the Needs of Youth in Crisis

Youth in crisis often end up in emergency departments, hospitals and even juvenile justice systems. Those who do not receive the proper care and treatment may experience serious behavioral health problems that persist into adulthood.

Feelings of despair and hopelessness can lead to harmful behaviors such as self-harm or suicide. Other risks include lack of healthy coping skills, mental health disorders and substance abuse.

What is a Crisis?

A crisis is a time when an individual experiences overwhelming emotions that cannot be controlled. These emotions often lead to feelings of fear or anxiety and can be debilitating.

Youth experiencing a crisis may also feel suicidal or have trouble functioning in day-to-day life. They may be at risk for substance abuse, family violence or even getting in trouble with the law.

Many counties and municipalities have programs, sometimes referred to as ACCESS, which provide 24-hour mental health services including support groups and referrals/linkage to community resources. Some of these programs also offer inpatient crisis stabilization treatment services.

Often, a crisis is caused by one specific experience or event but can be the result of a combination of stressors that have been building up over time. It is important to recognize the signs of a crisis and get help immediately. The sooner the individual gets help, the more likely they are to recover and prevent future crises.

Suicide Risk Assessment

There are a variety of risk factors for suicide, including mental illness, physical health issues and social isolation. In addition, people can feel hopeless for a number of reasons and may have a deep philosophical belief that death is the best option for them. Risk factors are not always closely related to suicidal thoughts and behaviors – and protective factors for one person can be very different from those for another.

NIMH has developed a standardized screening tool, ASQ (Ask Suicide Screening Questions), that can be used in patient care encounters in primary care settings. It is also available in a telehealth version for youth and adults.

Providers may be reluctant to use this tool or to intervene with people who are at risk of suicide, especially in rural areas. They may worry about poor outcomes, liability and the difficulty of documenting or billing for the service. One approach to overcome these barriers is to make training and resources for suicide risk screening accessible to rural providers.

Suicide Prevention

Teenagers need to know that they can talk to their parents about serious problems, and that their concerns will be taken seriously. Teenagers who feel misunderstood or rejected are at risk for despair and suicidal thoughts.

Psychiatric disorders such as schizophrenia, bipolar disorder and drug induced psychosis often develop in adolescence and can be particularly severe and hard to treat. Early detection and treatment can reduce the severity of these conditions and their risk for suicide.

Intervention strategies include promoting awareness of risk factors and warning signs, providing information and education, sponsoring community-based peer support programs, developing and improving crisis services, restricting access to lethal means (e.g., firearms), and interventions following a suicide. CDC categorizes suicide prevention efforts into eight broad categories. Most effective prevention activities integrate many of the strategies described above.

Treatment Options

Youth in crisis often have many different needs, including those related to family issues. Addressing the needs of the entire family helps prevent re-crisis, supports positive relationships and encourages safety and functionality within the home. Engaging the family, creating safety plans, holding family therapy sessions and submitting referrals for step-down care are all ways that crisis centers can support the family as a whole.

Cognitive Behavioral Therapy (CBT) is one of the most effective treatment methods to help children and teens understand their thoughts, feelings and behaviors. It teaches them how to change negative or unrealistic thoughts and behaviors into healthier ones.

For some youth, residential treatment is needed to further evaluate and address their mental health crisis. These settings are typically short-term and include therapeutic group homes or supervised apartment living, mentoring programs and day treatment services. Many of these settings also collaborate and work closely with child welfare and juvenile justice systems to ensure that a seamless transition occurs once your teen is discharged from the facility.