Youth in crisis face unique challenges: they are often living in conflict or crisis zones, facing stigma around mental health care, and are navigating the emotional ups and downs of adolescence.
Their stressors include feelings of persistent sadness or hopelessness, and harmful behaviors like substance abuse. These can be triggered by many factors, including: a lack of healthy coping skills; family communication struggles; and traumatic experiences.
Crisis Assessment
A comprehensive crisis assessment is a critical step in providing effective care for youth experiencing a mental health crisis. Youth in crisis may be at risk of suicide, self-injury, or harm to others. The CAT is an effective tool for assessing these risks and determining the level of service needed.
Youth and families want services to be accessible, understand them and have staff who have experience with CYP in crisis (CERQual-Moderate). They also value the inclusion of people who have experienced mental health crises within services (CERQual-Moderate).
During the COVID-19 pandemic, some CYP reported difficulty accessing care for their mental health needs due to school/university closures and disrupted routines, resulting in increased anxiety and feelings of isolation (WHO, 2021b). The development of community-based psychiatric support including round-the-clock home based crisis teams has been identified as a priority in England and elsewhere (NHS, 2018; WG, 2019). This includes the provision of services that are tailored to a client’s needs and preferences.
Stabilization
Often, youth in crisis are bounced around between detention, hospitals, and community services without continuity of care. This can lead to deterioration of their mental health and increasing utilization of public resources. States should consider establishing alternative first response options such as 23-hour observation units and Living Room models to help stabilize these individuals and redirect them into community-based treatment services.
Children’s Community Residences (CCR) provide a home-like environment for young people in crisis that provides supervision, structure, and skills training. One study found that a CCR intervention reduced ED visits and inpatient psychiatric service use by 25 percent, while saving Medicaid costs.
To support these efforts, states should evaluate the role of their Medicaid policy levers, including FFS and capitation approaches. They should also consider how to meaningfully engage youth and families with lived experience in the development of their crisis receiving and stabilization facilities. Examples include incorporating family representation on the advisory board of Wisconsin’s Children’s Community Stabilization Facility and Kentucky’s SIAC.
Treatment
Two years after leading pediatric organizations declared a crisis in children’s mental health, many kids and teens still struggle to get the help they need. They end up stuck in emergency departments for days or weeks waiting for a treatment bed; cycle in and out of psychiatric hospitals; contemplate or attempt suicide; and have difficulty staying in school.
Youth in crisis are best served by programs that offer a full range of services, including stabilization and assessment, individual and family therapy, group skills training, substance abuse counseling and other support groups. Some of these programs provide residential treatment, such as home-based and community-based crisis intervention and residential treatment facilities.
Effective discharge planning is key to keeping youth safe and supported. Clinical staff should be trained to start discharge planning the minute a youth meets admission criteria and collaborate with the family/caregiver(s) to identify resources. When possible, a plan should also include a referral to an outpatient clinic.
Recovery
Youth who need mental health services face many challenges, including those related to their substance use. They can also be disproportionately exposed to discrimination and stigma, particularly because of the way they look or the way they sound.
Participants described how their own experiences helped them empathize with and connect with youth in crisis. They emphasized the importance of maintaining trust by acknowledging generational trauma, culture, and identity and using the right pronouns. This was crucial in creating a safe environment where youth felt heard and accepted.
Peer support workers were also instrumental in connecting youth to services, advocacy and supports that could help address their substance use needs (e.g., counseling, harm reduction supplies, transportation). They described how their role offered flexibility within a structured framework and how this enabled them to respond to each individual’s unique situation. They were also able to draw on their lived experience to educate the public about the issues surrounding youth’s substance use.