Youth in crisis can end up stuck in emergency departments awaiting an open treatment bed; cycle in and out of psychiatric hospitals; contemplate, attempt or commit suicide; and face other issues like hunger, homelessness and poverty. These are some of the reasons why leading pediatric organizations have declared a mental health crisis for youths.
1. Assessing the Acuity of the Situation
While the majority of youth whose mental health needs escalate during the COVID-19 pandemic are receiving care in community-based settings, some are being placed in hospital emergency departments (EDs) when crisis services in their communities might be more appropriate.
This is especially true for racial/ethnic minority and marginalized youths, who report higher rates of suicide and serious consideration of suicide than their non-marginalized peers.
To help address this issue, states are exploring strategies to expand the capacity of crisis receiving and stabilization facilities for children and young adults by braiding a variety of funding sources together, including specialized managed behavioral healthcare programs that can provide more flexibility than traditional FFS payment models. Some are also incorporating family lived experience and representation on crisis settings’ advisory boards to ensure youth-serving systems are informed by youth and family perspectives.
2. Providing Support to the Family/Caregiver(s)
Young people live in a world with many stresses and pressures. They can be confronted by a breakup, a death of a loved one, natural or large scale disasters, bullying or other forms of social and emotional abuse; drug and alcohol use in their peer group; and often are overwhelmed by the stressors of everyday life.
Almost all children and youth provide some form of caregiving at home, such as helping out with chores or providing ongoing support for family members with health conditions. Structural challenges like depleted social services and uneven access to health care exacerbate the burden of caregiving for many families, including children and teens. This can lead to feelings of isolation and depression in these youth, as well as thoughts of suicide.
3. Providing Personalized Care
Most children and youth do not live independently, which means that when they are in crisis, it’s often not just about them. Family dynamics, communication struggles, and other societal pressures can exacerbate mental health challenges and may make it harder for the individual to reach out for help.
Providing personalized care can mean a variety of things, from meeting with the youth and family/caregiver(s) to create safety plans and hold family therapy sessions. It can also include addressing the family’s basic needs, such as food, housing and financial stability.
Many human services organizations are working to address these issues by implementing a wide range of youth crisis services that align with SAMHSA’s recommendations. One example is Youth Prevention Mentors (YPM), which brings treatment to the family home, allowing for more personalized and preventative support.
4. Stabilizing the Youth
In addition to treatment and care, youth in crisis also need support to address systemic issues like access to housing, lack of education and employment opportunities and the toxic stress that comes with living in communities that are struggling with racism and poverty. This could include helping youth build coping skills, addressing the trauma and anxiety they experience through social media and in real life, promoting healthy family communication and supporting a more cohesive and functional home.
Many states are implementing innovative approaches, such as in-home crisis stabilization programs. These provide an alternative to hospital emergency department (ED) treatment and are usually paired with mobile crisis teams. Ideally, these programs will help to divert youth from the ED and set them up for long-term recovery success.
5. Providing Step-Down Care
Teenagers in crisis experience a variety of emotions such as fear, sadness, or hopelessness. These feelings can lead to harmful or risky behaviors that impact the teen, family and community.
Providing step-down care can help them return home safely and with the skills needed to thrive. This can be done through recovery residences, which offer a residential level of care with transitional support services.
These programs can also provide long-term, live-in treatment options for teenagers in crisis. In addition to a mental health treatment component, they typically include credentialed family and youth peer advocates who support individuals throughout their stay and afterward. These efforts are important because they can help reduce the need for costly hospitalizations and other forms of intensive care. Ultimately, this can improve outcomes for both the teen and their family.