Youth in Crisis

Youth in crisis should be treated with a holistic approach that addresses both their mental and physical health. This means providing them with personalized care, including addressing trauma and avoiding re-traumatization.

For instance, addressing poverty can help address emotional distress and stunted development caused by lack of basic needs like food. It can also reduce substance abuse and self-harm.

Helping a Youth in a Crisis

For many children and youth, the stressors of daily life may trigger a mental health crisis. These stresses can range from hunger or homelessness to the loss of a loved one, family or friend. In addition, some conditions like bipolar disorder can lead to unexpected changes in behavior that increase the risk for a crisis.

Medical organizations including the American Academy of Pediatrics have made it clear that we are facing a national emergency in youth mental health. State leaders must work to strengthen our children’s and adolescent mental health systems to meet these challenges.

Strategies include establishing a robust continuum of care, incorporating child and youth-specific crisis services, and ensuring that community members are trained to recognize and respond to children and adolescents in emotional distress. To address unique barriers to service, programs must be designed with the input of youth and their families. This includes recruiting program staff from the communities they serve and educating them on personal biases.

Assessing a Youth in a Crisis

Children and youth have a different set of needs from adults. Because they do not live independently, crisis interventions with them must include their families. In fact, many young people experiencing a mental health crisis do not need to be hospitalized. They may require inpatient psychiatric treatment, counseling or other community services.

Unfortunately, a lack of access to these services is the biggest barrier for youth in need. Many youth get “stuck” in emergency departments (ED) waiting for a treatment bed; cycle in and out of psychiatric hospitals; contemplate, attempt or commit suicide; have drug overdoses; and struggle to remain in school.

To address these challenges, some states are implementing evidence-based models such as the Collaborative Assessment and Management of Suicidality program (CAMS; Jobes 2006) for youth. Other programs are offering temporary, short-term residential crisis stabilization beds for adolescents in need of respite from at-risk behaviors, family/peer problems and involvement with the child welfare system or juvenile justice system (for example Waymakers Children’s Crisis Residential Program). In addition, some providers are using telemedicine to provide care for youth who cannot safely return home.

Stabilizing a Youth in a Crisis

Across the country, young people are facing an urgent behavioral health crisis—one that led the United States surgeon general to declare a national emergency and call for immediate action just over a year ago. The crisis is brought on by a host of factors: poverty, lack of employment and economic stability, questions about political legitimacy and education, rising violence, and concerns about climate change.

To keep kids and teens out of the emergency department and other high-acuity settings, it’s essential that community-based services for youth be available. Mobile crisis services tailored to young people—and that can be requested by law enforcement and schools—allow them to be evaluated, deescalated, and connected with care. In-home crisis stabilization programs are another option. Both can provide short-term care and 24-hour supervision in a home-like setting that is more comprehensive than 23-hour observation but less restrictive than a hospital bed. They can also help families develop the skills, resources, and strategies they need to support their youth’s long-term recovery.

Supporting a Youth in a Crisis

From racial and sexual discrimination to societal disillusionment, young people are dealing with many difficult circumstances. These challenges are contributing to a mental health crisis cited by the U.S. surgeon general and reported by multiple state health agencies and organizations.

Some youth are in the midst of a traumatic experience that is impacting their ability to cope, such as the loss of a loved one or a natural disaster. In addition, other stressors, like poverty, are putting youth at risk of developing mental health problems.

During the psychosocial assessment, a crisis worker should interview both the youth and their family/caregiver(s). This will help build trust and support development of the clinical team that can identify ways to support the family in their journey to recovery. These can include setting up appointments with outpatient providers, submitting referrals for step-down care and supporting safety planning. The goal should be to empower the family and set them up for long-term recovery and success.