Youth in crisis often need immediate attention and intervention. They can be at risk for harming themselves or others and can show signs of severe agitation/aggression, destruction of property and hostility.
Many teens face many challenges including mental health issues, exploration of sexuality and relationships and substance abuse. Providing a comprehensive inpatient assessment can make a huge difference, not only in getting them treatment sooner but also influencing their long-term recovery and success.
What is a Crisis Center?
A crisis center is a resource that provides mental health services and emotional support to individuals going through a behavioral health crisis. Many state and local programs that answer calls for the Lifeline also operate their own crisis centers or provide access to them through a phone line or other resources, such as the free text line (911-WELL).
A person in crisis can seek help from a center by calling a 24-hour hotline (such as the National Suicide Prevention Hotline), using a smartphone app that connects callers with counselors or through walk-in facilities like clinics or psychiatric urgent care units. In addition, some communities have a family-based crisis home support program where a person goes to live with a screened and trained “professional family” for short-term assistance.
It is important for clinicians to become familiar with local and state-wide crisis programs and services in their area so they can help patients in crisis find the right resources quickly. For example, some crisis programs, such as NYC Well, offer phone counseling and referrals to mobile crisis teams, which are available 24/7/365.
Assessing the Acuity of the Youth
Pediatric behavioral health visits to EDs are increasing nationally and may be inappropriate, as a subset of youths with serious mental health conditions are likely to not be treated or not be adequately treated in an ED setting (1, 2, 11). These upward trends highlight the need for alternative, community-based approaches to service delivery.
One such approach is a mobile crisis intervention service that can be accessed by calling a single number that connects to a call center, where a trained staff member can assess the situation and determine the level of risk and need for services.
A recent study used propensity scores and outcome analyses to examine the impact of a mobile crisis service on ED utilization among Medicaid-eligible youths in Connecticut. The results showed that youths whose first psychiatric ED visit occurred while they were clients of the mobile crisis service had fewer subsequent behavioral health ED visits than a comparison group that did not use the mobile crisis service (23). All data pertaining to ED utilization was obtained from deidentified claims from Medicaid through an administrative service organization.
Providing Personalized Care
A specialized crisis program/center provides individuals with the support and treatment they need in an environment that is safe for them. Youth in crisis can be voluntarily or involuntarily transported to the crisis center. This is often a better option than getting involved with police who may not be as helpful in addressing the individual’s mental health needs.
A specialized crisis team will complete a comprehensive clinical assessment that includes a psychiatric evaluation and medication management if necessary. Treatment at the YCSU is focused on helping patients understand the cause of their crises and how to better manage similar situations in the future by increasing healthy coping skills. Upon discharge from the YCSU, staff will provide families/caregiver(s) with clear next steps for maintaining safety and individualized resources that will help to set them up for long-term success. Throughout the process, collaboration and partnership with family/caregiver(s) is critical to ensure the effectiveness of the discharge plan.
Supporting the Family/Caregiver(s)
When a youth is in crisis, their emotions and behaviors may seem out of control. A crisis center helps them gain control and find a way to cope with their situation. The program works with the family to provide the support and services that they need.
A youth in crisis can be referred to a program through their primary care physician or a hotline like 988, which connects those experiencing a mental health, substance use or suicidal crisis with trained crisis counselors. The number is available nationwide, free of charge and accessible on land lines, cell phones or voice-over-internet devices.
Hillside provides intensive home-based services for kinship families that have legal custody or an informal care arrangement with children up to age 18. The specialized program offers intensive community-based responses to help stabilize situations, support families and provide connections to long-term services. These services can reduce the need for out-of-home placements and other higher levels of care.