Mental Health Crisis

What is a mental health crisis & what to expect when one occurs

How do I know if my child is having a crisis or a mental health emergency?

Source: From ACMH, http://www.acmh-mi.org/about/

There are times when a parent needs help quickly – when children can’t calm down, are uncontrollable or may be in sudden danger of hurting themselves or others.

A crisis situation exists any time that your child is no longer safe to himself or others or when there is a need for immediate action or intervention. It is usually a time when all of your energies are being demanded in order to care for your child.

Some signs that your child may be experiencing a mental health crisis include:

Rapid mood swings
Extreme energy or lack of it, sleeping all the time, or being unable to sleep
Severe agitation, pacing,
Talking very rapidly or non-stop
Confused thinking or irrational thoughts
Thinking everyone is out to get them or seeming to lose touch with reality
If they are experiencing hallucinations or delusions
Making threats to others or themselves
Isolating themselves from friends and family, not coming out of their room
Not eating or eating all the time, rapid weight loss or gain
Suicidal thoughts and statements such as “I want to die” or even possible vague statements such as “I don’t want to be here anymore”

This list above contains many but not all the possible signs that your child may be experiencing a crisis. It is best to follow your instincts. Remember you are the expert when it comes to your child. If you feel your child is behaving much differently than normal or if the situation seems like it is getting out of control and you fear you may not be able to de-escalate it – then your child is most likely experiencing a crisis.

Once you decide that indeed your child may be having a crisis or mental health emergency you’ll want to consider the following questions:

Do you feel your child is in immediate danger to themselves or others?
Can you handle the situation yourself or do you need help?
If you need help- what type of help do you need and from who?

If the answer to question 1 is yes, and your child’s life is at risk or someone else’s life is in danger you need to get help right away! If you feel your child or family is in imminent danger call 911 but keep in mind that once police enter your home they are in charge of the situation and control what happens next including where your child may be taken.

CRISIS Contact Information*

9-1-1
BHPD: 310-550-4951
Ronald Reagan UCLA Medical Center (Emergency Room): (310) 825-9111
- 757 Westwood Plaza, Los Angeles, CA 90095
- For emergency mental health evaluation

For a mental health evaluation service at home call the Psychiatric Mobile Response Team: 800-854-7771

Other emergency resources including the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) can be found on the ACMH Get Help Now Page.

*For additional resources, please see full BHUSD Referral List

When you call 911 or crisis services be sure to let them know that your child is having a mental health emergency as that may trigger them to send someone who is trained in supporting children and youth experiencing a mental health crisis. You may also want to ask if they have a children’s crisis team as they will be trained to intervene in similar situations.

Try to give the person you talk to as many details as you can about what specifically is happening and any other background information you feel may be important.

What if I am worried that my child is suicidal but I am not sure?
It is really important that you follow your instincts in these situations. If you have a feeling that your child may be considering taking his or her own life, you need to pay attention.
If you are worried - ASK!

Many parents are fearful that if they ask their child if they are considering killing themselves that it will put the idea in their head or that talking about it may cause them to attempt to take their life, but research actually shows that talking about suicide reduces the risk.

We understand that having this conversation with your child is not an easy thing to do. In fact it can be terrifying and overwhelming so we have listed some steps and tips below to help you start the conversation.

Tell your child what you have observed that is worrying you.

For example:
Mitchel I’ve noticed that you have been sleeping a lot, staying in your room and are not interested in going out with your friends anymore or hanging out with us. I also saw that you wrote I don’t want to be on this planet anymore all over your notebook.

Julie I think I heard you say you “you wanted to die”.

Let them know you love them you want to help.

"I’m worried about you and want to help."

Ask them as calmly and directly as possible if they have considered killing themselves or taking their own life?

For example say:
Have you thought about killing yourself?

If they say anything except a strong no, then ask:

Have you thought about how you might do this? or Do you have a plan?

**Having a plan may mean they are at a higher risk level / not having a plan does not mean there is no risk.

Do not leave them alone if you feel they are at immediate risk. If you feel they are immediate danger – call your therapist, local CMH crisis center or go to your local emergency room for help. If you do not feel you can safely transport your child and it is an emergency situation you may need to call 911.

If you are unsure what to do it can be helpful to call the National Suicide Prevention Lifeline at 1-800-273-8255. They have trained people that can help you and your child 24 hours a day 7 days a week. If the crisis is taking place during school hours you can contact your student's school counselor or BHHS Wellness Counselor, Mrs. Norman-Franks.

If your child convinces you that they are not at immediate risk and you do not feel they are at immediate risk, still be sure to get in contact with a therapist for an evaluation or advice about what to do next. In addition be sure to share information with your child about suicide hotline numbers and other resources and be sure to let them know they can come to you at any time.

Other things you can say or do that may be helpful:

Let them know that they are not alone and that you are there for them no matter what!
Reassure them that lots of young people have suicidal thoughts but do not act on them. Sometimes just knowing that other children and teens sometimes have those thoughts can make them feel better.
Try not to discount their feelings or convince them they shouldn’t feel this way - it can feel dismissive or non-supportive.
Let them know that you want to help them and that you will help them get connected to the help they need.
Although this may be one of the hardest things you ever have to ask your child - asking your child directly if they have thought of suicide and talking about suicide lets your child know it is ok to come to you no matter how badly or hopeless they feel. You can be a protective factor that helps to lower your child’s risk. Sometimes just having the opportunity to talk about how badly they feel can be a great relief to young people.
If you feel your child is not in immediate danger of hurting themselves or others, but still needs help right away. You then have to decide if you can handle the situation yourself or if you need help to figure out what to do next.

RESOURCES:

SAMHSA’s Helping Your Loved One Who Is Suicidal – A Guide for Family and Friends

If you feel you need help during any crisis with your child, contact: Your child’s therapist or treatment team if they have one - they may be especially helpful as they know your child and their history.
When you call ask if they think your child, based on the current situation may need to be assessed, need emergency services or perhaps to be hospitalized? They may have you bring your child in to be assessed or they may send you to the local crisis services, hospital or other location directly.

If your child does not have a therapist or if they are not available you can:

Call your local Community Mental Health Crisis Center- click here for contact numbers and select your county.
Transport your child directly to the crisis center or emergency room if you feel you can do it safely. If possible, call ahead to let them know you are coming so they can be ready for your child when you get there.
Depending on the situation or who you call for help you may:
Have to wait for a call-back; Be advised to monitor the situation until your therapist can see your child; Be asked to take your child in somewhere to be assessed; or Be advised to take your child to emergency or crisis services or a local emergency room.
If you need to take your child in somewhere:
Decide if can you safely transport your child. If not, do you have a support person that could help you? If you feel you cannot safely transport your child and do not have anyone to help you let the place you are taking them know that and ask what they recommend you do.
If you have to wait for someone to call you back or if you have been advised to monitor the situation until your child can be seen by your regular therapist; keep in mind that things may change quickly. If the situation or your child’s behavior escalates while you are waiting you may need to take other actions. If at any time you feel the situation has reached a level that that you need additional help right now in order to keep your child safe call for help!

Steps to try to calm/control the situation while you wait for help:

If your child has a safety plan, follow any planned strategies you have in place.
If you do not yet have a safety plan, try any strategies you feel may be effective in this particular situation.

You may also want to consider some of the following tips to help de-escalate the situation:

Try to stay calm

- Speak slowly and confidently with a gentle, caring tone of voice
- Do not argue or challenge your child even if what they are saying seems unreasonable or outrageous to you
Do not threaten
Do not raise your voice or talk too fast
Use positive words instead of negative words
Stay with your child but try not to restrict their movement
Listen actively and try to give positive support and reassurance
Realize you may have trouble communicating with your child
Ask simple questions and repeat them if necessary
- Say, “I’m here. I care. I want to help. How can I help you?"
- Empathize with how your child is feeling.
Try not to take your child’s actions or comments personally
The increased intensity of the situation can sometimes make it more difficult for us to hide our own fears or opinions so do your best to stay calm.
Don’t handle the crisis alone if you have people who can support you such as family, friends, neighbors, people from your place of worship, or people from a local support group
Don’t threaten to call 911 unless you intend to. When you call 911, police and/or an ambulance are likely to come to your house. This may make your loved one more upset, so use 911 only when you or someone else is in immediate danger

Keep in Mind That:

Your child may be frightened by the feelings they are experiencing.
Symptoms such as suspiciousness or distorted thinking can cause youth to be fearful and not trust other people even you
It can sometimes be helpful to take a break from the conversation for a while when you are waiting to get help.

Planning Ahead for Safety

For some children it is not a question of ‘if’, but rather a question of ‘when’ a crisis will occur and in those cases some advance planning can make a big difference in getting the care and intervention needed for your child and for your family.
If you have a safety plan in place it should list steps and strategies to help you. If you can plan what you will do, who will contact and where you might go for help during a crisis it can be incredibly helpful.
If you do not yet have a safety plan, ask your child’s therapist or treatment team to help you to create one. If your child is placed in an emergency treatment placement or hospitalized ask the staff work with you to create one before your child is discharged. Sample Safety plan (BHUSD)
It is important to think about your child’s safety and also the safety of other members of the household. If your child is a risk to him or herself or their siblings, they may need to be hospitalized.
A child who is struggling with may not use good judgment, self-control or even be aware of the consequences of his or her actions. They may be fueled by emotions and may not be able to think logically. For some children and youth the ‘fight or flight’ instinct often takes over during a crisis and their actions may be sudden, reckless and even dangerous.

Additional Preventative Safety Steps:

Some children and youth are at high risk and experience crisis situations on a regular basis.
Some steps that other parents have taken to safeguard their child and family in case of a crisis include:
- Locking up guns, knives and other sharp objects.
- Using the child safety locks on car doors to keep a child from jumping out of a moving vehicle
- Removing furniture and heavy objects from the child’s room that might be thrown during a rage
- Locking up all medications and other substances to keep out of reach
- Putting a lock on the refrigerator if a child has uncontrolled eating binges
- Having a plan and a safe place for other children to go when a crisis occurs
- If your child often tries to run or flee you may want to consider getting training on safe ways to restrain a child.
- Your child’s psychiatrist or therapist can offer input or refer you to local resources for training.

What Causes a Mental Health Crisis?

There are some events/situations that could trigger a mental health crisis in any child or youth including a breakup, death of a loved one, natural or large scale disaster, physical, sexual or verbal abuse, loss of home, failing grades in school, ill family member or caregiver, divorce, loss of a friend, loved one or hero to suicide, or being a witness to a violent act/accident, physical assault or violence.
It is important to keep in mind that children and youth with mental health disorders sometimes have more difficulty than others dealing with stressors and that their mental health condition itself may lead to a crisis situation for no apparent reason. In addition changes in medication or other factors may make a mental health crisis more likely.
Sometimes even when we have all the right supports services and treatment in place mental health crises can still occur.

Special Situations: Police Intervention

Depending on the age, size and strength of your child, as well as the details of the crisis, it may be necessary to call for police assistance in either restraining your child, transporting your child to the hospital, or tracking down a run away.

Final Thoughts:

It is important to keep in mind that even if you do everything right and follow all the steps you know how to do to the best of your ability – situations can still get out of hand and may be more than you can handle. It doesn’t mean you have done anything wrong just that you may need some additional help to help your child.
Crisis situations can be stressful, frightening and exhausting for you, your child and other family members too. It is important to make sure you are taking care of yourself and getting the support you all need as well!
Asking for help and knowing where to get it and how is sometimes the hardest part. If you still need help, have additional questions or need additional information feel free to consult with BHHS Wellness Counselor to learn more about mental health support services provided through NormanAid Wellness Center and in our community.

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