Youth in Crisis

Youth often encounter a mental health crisis that requires immediate help. They may experience feelings of persistent sadness and hopelessness, or a desire to hurt themselves, including self-injury (like cutting or burning).

These issues can be made worse by the COVID-19 pandemic, school structures that have left some kids without consistent learning opportunities, and financial insecurity. States have established youth-specific crisis receiving and stabilization facilities to provide immediate assessment and connection to services.

1. Identifying the Youth in Crisis

Teenagers go through stormy periods, and it can be hard for them to see a proverbial light at the end of the tunnel. They may be struggling with mental health issues, family relationships, school performance, socialization and/or isolation, substance abuse or other high-risk behaviors.

Unemployment and other economic concerns are also causing stress. Many teens are also experiencing anxiety and depression, with black youth twice as likely to die by suicide than their white peers.

To address these growing needs, states are establishing youth-specific crisis receiving and stabilization facilities to provide immediate assessment, evaluation and connection to services. These settings are more comprehensive than 23-hour observation units, but less restrictive than inpatient hospitalization. In addition, these facilities are designed to be culturally competent and developmentally appropriate.

2. Conducting a Psychosocial Assessment

Getting young people to volunteer information about their social circumstances and risk factors can be challenging. However, identifying these risks and strengths can improve patient compliance and support interventions that promote current and future health outcomes.

Psychosocial assessments can take a variety of forms. One approach is to use structured clinical interviews with open-ended questions to explore the client’s presenting concerns and symptoms. Others include timelines and eco-maps, which ask clients to mark significant life events on a timeline or visually represent their social network and the strain or influence of each relationship.

Shorter evaluations can be conducted when a specific area of concern is identified, such as substance abuse or suicide risk. In addition, periodic reassessments should be conducted throughout mental health treatment to track progress and adjust the care plan as necessary.

3. Engaging the Family/Caregiver(s)

Adolescents face a wide array of imbalanced challenges including social isolation, academic disruption, parental job loss and adversity from natural disasters. Their challenges also include being exposed to mass shootings, suicide attempts, and other forms of trauma, loss or abuse.

Help adolescents develop coping skills by teaching them problem-solving techniques. This can be done by teaching them to identify the root cause of their crisis and brainstorming possible solutions. It can also be done by encouraging them to seek out a trusted adult they can talk with about their crisis.

Increasingly, state agencies are seeking family members with lived experience to be included on advisory boards or the leadership of the youth crisis system. For example, Wisconsin requires that its governing body of the State Interagency Council for Services and Supports to Children and Transition-Age Youth (SIAC) have parents with lived experiences on the board.

4. Stabilizing the Youth

Children can visit a psychiatric emergency room for help with an emotional or behavioral crisis. In addition, home-based crisis intervention programs can provide care and short-term management for youth 20 and younger in a safe setting.

Address the mental health needs of at-risk youth, including racial and ethnic minorities, LGBTQ+ youth, foster youth, and youth involved in the juvenile justice system. Sustained investments in equitable prevention, promotion, and early intervention are needed.

Educate adolescents about stress and anxiety management. Help them learn how to solve problems by identifying the issue, brainstorming possible solutions, and evaluating these options. Lastly, teach them to be resilient and see setbacks as learning opportunities rather than insurmountable obstacles. This will help them feel more in control of their lives.

5. Supporting the Family/Caregiver(s)

Children and youth experiencing mental health crises are often involved with multiple systems. For example, as many as 80 percent of foster care youth and 70 percent of youth involved in the juvenile justice system have serious behavioral health needs. To better address the needs of these vulnerable youth, some states are establishing crisis receiving and stabilization facilities that align with child-serving systems to prevent duplication and strengthen care coordination.

To help reduce the number of youth readmitted to crisis receiving and stabilization facilities, some states are exploring evidence-based policies including post-discharge planning and intensive wraparound services to support a successful transition from these settings. Many are also seeking input from family caregivers with lived experience to help ensure that these settings are responsive to their needs.