Mental Health Crisis: The Cycle of our Lives (Part 3)

After the Crisis

There are so many possible outcomes after the crisis is over, that it would be impossible for me to cover them all in detail in just one blog.  So instead, I will briefly outline some likely scenarios: favorable and others not so much.  No matter what final decision is made in the Emergency Department (ED), make sure your child’s Therapist and Psychiatrist are aware of the situation and kept informed.  An open and honest avenue of communication with these professionals will make the follow up treatment so much easier.

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Photo by Cordell and Cordell

Prior to being discharged from the ED, a safety and treatment plan will need to be created.  The complexity of the plan will depend significantly on what your child needs, once the most severe symptoms are treated.  I will discuss a few that my family has experienced over the years, from the least intrusive to the most restrictive.

  1. Homeward Bound:  The simplest and most common outcome has been that our child was discharged with a safety plan in place requiring additional parental supervision and a follow up appointment with his Psychiatrist.  In most cases, a medication evaluation is recommended.  You may find yourself frustrated by spending so much time waiting in the ED for this outcome, but I remind you of the possible tragic consequence if you had not sought help.
  2. Intensive Outpatient Treatment:  This is a much more intense and intrusive therapeutic option without removing the child from the home.  There are several ways this type of therapy can be provided.
    1.  In-Home Therapy –  A form of intense therapy, where more than one therapist will come to your home to provide individual and family therapy.  This usually involves 10-30 hours a week in the home with all family members.  We have had mixed results with in-home therapy. It requires a major commitment on everyone’s part, not just the child. For this to work, you must have an open mind, and be agreeable (personally, I would prefer willing or open, but it’s your decision) to change both habits and your frame of mind.
    2. Day Treatment –  A combination of school and therapy, day treatment provides an emphasis on coping skills and strategies.  This type of treatment is especially useful when a child is struggling behaviorally and emotionally in a school environment.  Day treatment can be a short term step-down service or a long term schooling alternative.
  3. Inpatient Hospitalization:  A short term out of home placement in a medical facility for supervised, controlled medication treatment and stabilization.  Now that’s a mouthful!  Again we have had some mixed results depending on the facility.  Our experience with a Children’s Hospital has always been stellar in regards to treatment and communication.
  4. Residential Facility:  One of our least favorite options.  This long term treatment is reserved for when nothing else has worked.  Residential Facilities are used in conjunction with the legal system for a few reasons.  First, the cost alone would make a person faint in astonishment.  I personally have not seen a private insurance policy willing to cover this treatment.  Second, these facilities are reserved for the last possible resort.  Despite the common misconceptions, Social Services would prefer to keep a family together.

I know this has been a lot of information to process, but keep your head up.  As I mentioned at the beginning of this 3 part op-ed, you are not alone.  There is a wealth of knowledge and support available, no matter what form it comes in.  Ask your mental health provider about local groups in your area.  Also, check out some of the helpful online groups below:

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Mental Health Crisis: The Cycle of our Lives (Part 2)

The Emergency Department

For whatever reason, your child has found him/herself in a mental health crisis.  When the crisis happens, no matter where or how it started, the most common direction is to your local Emergency Department (ED).  In the remainder of this article, I will be discussing our experiences with the Children’s Hospital ED.  Although we have dealt with many EDs over the years, the Children’s ED has been one of the most comforting and helpful facilities.  Other than a few policy exceptions and facility setup, your experience hopefully will be somewhat similar.

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Via PublicDomainPictures.net

Ultimately at this juncture in the crisis stage, the why of the matter will not be nearly as important as the when, what, and where?  Where do we go from here?  Where do we go to get help?  When will my child get the help he/she so desperately needs?  What is happening?!  Let’s take a minute to provide some answers and directions to these questions.

Where do we go from here? Where do we go to get help? My child may be suicidal, homicidal, or possibly experiencing a manic state.  Depending on the severity, you have choices.  To avoid going into too much depth lets focus on your ability to keep the lid on the pan so to speak.  The thoughts are there, but no real action has been taken.

  • You could call a crisis hotline – The hotline is there to work through the crisis with you and your family, and help you come to the safest and least restrictive method to solve the crisis. This may well be as simple as an individual or family therapy session to create a safety plan until such time as more permanent arrangements can be made.  My experience is it is more of a small band aid applied to a much larger wound.  Hotlines are great for deescalating a crisis as it occurs, but usually unable to provide the necessary follow up to avoid the crisis again in the future.  You will probably be referred back to your primary care physician and/or psychiatrist for additional treatment at a later date.
  • Visiting the ED – In most of our cases (except a few rare instances) the crisis has simmered to a bubbling boil once you arrive. It still does not change the fact that both you and your child are confused, scared, lost and possibly angry at each other or the situation.  At this point, you probably are wondering why you are even reading this, and asking yourself what is the point.  Take a second and let me redirect your attention to the breathing exercise we used earlier.  Steady, slow deep breaths, we don’t need to add hyperventilating to the list of problems.  The ED will be your first step in getting your child the much needed assistance you have been looking for.

When will my child get the help he/she so desperately needs? Great question!  Almost all of us have been to the ED for a broken arm, concussion, illness, etc.  Well the process is somewhat the same; you are seen in order of urgency as rooms become available.  The difference is there are a lot less rooms available for mental health emergencies.  We are talking about a handful of rooms if you are lucky.

What is the process once you have a room?

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Image by Susan Naro
  • Your child will have to change into scrubs to ensure he/she does not have anything unsafe on their person. Additionally, the doctor will perform a medical examination to determine your child does not have any bruises or injuries.
  • You will be separated from your child on more than one occasion. I know the first few times my wife and I were separated from our child during his crisis everyone’s stress and anxiety levels increased considerably.  There are a couple reasons they do this.  First, it is important for the doctors to get the perspective of the child without having their parent’s unintended influence.  Second, they need to know the child is not in an unsafe situation at home.  This may feel unnecessarily intrusive, but it really is in the best interest of the child.
  • There may only be one on-call Psychiatrist who serves several hospitals at one time. This doesn’t mean you shouldn’t be informed on a regular basis on what’s going on.  Don’t hesitate to ask any and all questions you think are necessary.

Here is where the wait truly begins.  Every ED room setup for a mental health emergency I have ever been in has been stripped down to the bare bones.  That means no television or entertainment!  We have also encountered EDs restricting any outside items for both the patient and parents, including cell phones for safety and privacy concerns.  The next section will come in handy if you are not limited by the ED policies.

Hopefully you are reading this before the crisis occurs so you can take advantage of some tips my wife and I have learned over the years.  The most important one being pack a “Go Bag”.  You might be asking yourself, “When did I become a soldier, doctor, or a member of ‘The Agency’?”  Well, it’s the same concept.  You need to drop everything and go, with no time to pack.  Hence, the pre-packed, grab and go bag of goodies needed for hours or even days at the ED.  No, that is not a misprint, I meant to type days.  Below are some ideas for your “Go Bag”:

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Via Giphy
  • Small games: Deck of Cards, Card games (Uno, Skip Bo, etc.), Yahtzee, and Dominos. Coloring books and crayons or markers (most EDs restrict the use of pencils or pens by the patient), crossword puzzles, and any other easy to pack fun items.
  • Fidget Toys: Stress Balls, Bubbles, Spinners, Playdoh, or any other small, easily accessed items to help calm you or your child.
  • Change of Clothes: You are going to be there awhile.  Why not be comfortable?  Some sweatpants, slippers, or whatever makes you comfortable when you are relaxing and sleeping. You might want to consider layers.
  • Toiletries: If you don’t have someone to relieve you so you can go home, being able to brush your teeth, clean up, and freshen up after a long night can make a huge impact on your mood.
  • Blanket: Hospitals are known for their warm blankets, which my wife loves!  But you may need something a bit more substantial.  Also, bringing a favorite blanket of your child’s may help reduce the anxiety he/she is feeling.
  • Water bottle and snacks: You can save a lot of money by bringing your own food and drink. Vending machines and eating out can become very costly, very quickly.  I highly recommend packing some long lasting or non-perishable snacks, like crackers, chips, dried fruit, nuts, etc.
  • Additional Ideas: Tailor the “Go Bag” towards your family’s needs and interests.  Keep in mind safety concerns (so obviously no craft items requiring scissors, needles, pins, or any other sharp tools).
  • For you: Phone chargers, books, or music. At this point it is not just your child that needs to be occupied. When your child calms down, and they will in time, they won’t need/want all your attention.  Also remember you will have to keep the bag with you whenever you leave the room, so try not to make it too heavy.

Every crisis and experience will be little different, but there are several commonalities which the items above will make the process smoother and more bearable.  When possible a little preparation and knowledge ahead of time can make all the difference in the world.