Children and teens are experiencing behavioral health challenges that have steadily gotten worse over the past decade. These include social isolation, the loss of family members to the COVID-19 pandemic, physical and emotional abuse, lack of stable housing and strained relationships with parents and teachers.
To address these needs, states are establishing youth-specific crisis receiving and stabilization facilities to provide immediate assessment, support and connection to care.
1. Assess the Situation
For over a decade, rates of mental ill-health among youth have been on the rise. The COVID-19 pandemic has exacerbated this trend, with high levels of depression and anxiety among at-risk youth and increases in self-injury and suicide.
Many social and economic factors have varying impacts on the mental health of American youth. There are increasing trends in the instability and identity explorations of adolescence, economic precarity (including insecure employment and heightened exploitation by financial institutions), social isolation, cyberbullying and online exposure to violent and disturbing content, and a lack of family support systems.
Pediatricians are uniquely positioned to help address the crisis by helping to de-stigmatize mental health care and providing families with access to trusted, comprehensive and community-based services. Pediatricians can use their close relationship with children and teens to encourage early and ongoing engagement in evidence-based interventions. They can also promote a system of care that integrates crisis intervention services with primary and preventive healthcare.
2. Assess the Youth’s Needs
Virtually all teenagers experience difficult and stormy periods. However, when these periods escalate into mental health crises, they require intervention. The signs and symptoms of a mental health crisis can include unexplained physical complaints, difficulty concentrating in school or work, withdrawal from social activities, loss of interest in extracurricular activities, regressive behaviors like thumb-sucking or bedwetting, a decline in academic performance, and suicidal thoughts or behaviors.
These issues can be influenced by both proximal and distal factors. Proximal factors reflect those within the youth’s immediate environment such as developmental changes, family structure and support, education, diet and health, social media use, childhood trauma, and bullying. Distal factors are more macro-level issues such as unemployment, poverty, climate change, politics, and global economic disparities.
Pediatricians are in a unique position to identify children who are at risk because of individual circumstances and to destigmatize mental health care. This can be done through establishing a trusted relationship with young families and through routine well-child visits where mental health screenings are recommended.
3. Refer the Youth to Treatment
Children and adolescents with mental, behavioral and emotional problems often struggle to receive the treatment they need. Some are unaware of their condition and resist being referred to a treatment program, while others recognize their needs but fear living outside their home in a residential setting.
The key to successful referrals is building rapport and identifying the young person’s needs. This may be accomplished by creating a conversation that is nonjudgmental, approachable, and affirmative. The use of open-ended questions and active listening can help to build rapport as well.
It is also helpful to provide the young person with specific information about the services that are available to them. This can be done by providing them with a brochure or other written material, as well as by assisting them in making an appointment with a service provider. To make the process as smooth and seamless as possible, it is recommended that a simple referral tracking form be used to document each referral.
4. Stabilize the Youth
The key to effective crisis response is building trust with the youth. When staff approach the youth in a calm and confident manner while maintaining a safe distance, it allows them to express their concerns without fear of repercussion or being judged. Developing empathy and showing understanding are also important.
When a young person is in crisis, they often feel they have nowhere else to turn. They may have experienced trauma in their lives, or they may be living with neglect and abuse. In order to help them stabilize and set them up for long-term success, it is critical that they are provided with a safe place to stay, and that the appropriate care is in place.
Mobile crisis teams like those in Maryland allow for quick response to youth, and can stabilize, assess, and support them without putting them at risk by taking them away from school or their families. Similarly, crisis receiving and stabilization facilities provide a safer and more secure environment than 23-hour observation units but are less restrictive than inpatient care.