What to Do If Your Child Experiences a Mental Health Emergency

My son, Maverick recently got his first job at the snack stand of our local pool. Groups of hungry kids, chlorine dripping from their goggles as they hop on bare feet, line up as they wait their turn to order at the window.

I know how nervous he gets when he does something new, but Maverick has a knack for making things look easy. He remembers the names of his friends' younger siblings, smiling and chatting with them as he hands out candy and popsicles. Some teenagers don't smile much at all, but Maverick smiles a lot.

It wasn't always like this, though. Three years ago, Maverick tried to take his own life.

No one talks about what to do if your child attempts to die by suicide. There's no guidebook, no instructions for how best to address the trauma with younger siblings, particularly those who witnessed the attempt. How does a parent address their own trauma after nearly losing a child to suicide? No one knows.

People don't talk about it.

Looking back, there were signs of trouble; moving forward, I'm armed with an arsenal of tools if we ever find ourselves in that place again. However, let me be clear: navigating the American healthcare system when a child is in the midst of a mental health crisis is incredibly overwhelming, and I was terrified almost the entire time that I would make a mistake that would cost us his life. I can't tell you how many times I wished for clear instructions—for someone to parent me. What follows are just a few things which I wish I knew. What follows is what you may want to do, should you ever find your child in the midst of a mental health emergency.

What Is a Mental Health Crisis?

Let's start with the basics: What exactly is a "mental health crisis?" Emma Carline, LPC-S, NCC, co-owner of Clart͑é Counseling, defines it as a situation where an individual is a threat to themselves or others. Self-injury (including eating disorders, suicidal ideation or attempts, cutting, and other forms of self harm) substance abuse, and violence towards others fall into this category.

Three of the most common mental health crises experienced by kids ages five to 18 years old are depression, anxiety, and/or aggression, according to Lanhuong Nguyen, a board certified child and adolescent psychiatrist. She says that depending on the severity of symptoms, there are psychiatric disorders that can negatively impact a person's life and trigger a crisis, ranging from generalized anxiety disorder to depression, bipolar disorder, attention-defecit hyperactivity disorder (ADHD), and other things.

Plainly speaking, there are a broad spectrum of things that can cause a mental health crisis. Genetic predisposition mixed with the right cocktail of stressors is sometimes enough to do it, and there isn't a one-size-fits-all description of what that might look like.

How Do I Know If My Child Is 'In Crisis' or Having a Mental Health Emergency?

Sometimes, you know when your child is in crisis. There are mood changes. There are behavoiral changes. That, or your gut shouts that something is wrong. But other times, things are little less obvious. Some kids are masters at hiding things in plain sight. Kimberly Zapata, an associate editor at Parents, explains that she would hide everything from her mom.

"My depression, fears, scars, anxiety... heck, even my severe suicidal thoughts were a secret," Zapata explains. "I kept my grades up. I was active in nearly a dozen clubs, and I held down a job. To the outside observer, I was a studious overachiever. Nothing seemed amiss. But inside, I was drowning."

If your child is refusing to get out of bed, runs away from home, or is having thoughts of suicide, those are considered emergency situations. If you notice a significant weight gain or loss, changes in behavior, or if your kid suddenly begins saying things like "I don't deserve to be here," that is a sign that something is wrong.

"In teens, we tend to see a decline in grades, withdrawal from social settings, lack of interest, behavioral outbursts and a tendency to isolate," said Carline.

The takeaway? Pay attention to major changes.

I Recognize the Signs and Symptoms. What Should I Do?

When I realized that my son had made an attempt to end his life, it felt like everything was happening in a dream. Crucial moments are often like that; I heard myself saying calm words out loud, but my inner monologue was something along the lines of "OH MY GOD OH MY GOD."

The biggest rule in a moment of crisis is to avoid freaking out on your child. Keep your demeanor calm and nonjudgmental. Don't make it about you or your feelings. This is not an attack on you or your parenting, so check your ego at the door. If you've built a foundation of open communication and honesty with your kid, use those skills to ask direct questions about what is going on. If you've never talked openly about mental health before now, take this as an opportunity to start.

If your child has a therapist, reach out to them for direction. If they don't have one, call their doctor or pediatrician. Depending on the situation, you may need to bring your child in for an evaluation. At that time, you may be referred to a pediatric psychiatrist or, if the situation calls for it, the emergency room. You may also need to dial 988—the Suicide and Crisis Lifeline. Your response will depend on the situation and the urgency in which you need care. That said, it is important to note if your child has made an attempt on their life, 911 should be called immediately. This ensures your child is able to be cared for properly—and be kept safe. It also helps them receive the support they need.

As for our case, Maverick had a therapist already; she was able to see him that very day. After meeting with us, she determined that he'd frightened himself so badly that he wasn't in immediate danger of attempting self harm again—meaning we did not need to take him to the hospital. Instead, I contacted our pediatrician for an emergency referral to a psychiatrist, who got him in quickly and was able to get him on the right combo of meds to stabilize his moods. We then located an Intensive Outpatient Program (IOP) for adolescents, which consisted of thrice-weekly group therapy for him and twice-weekly group therapy for parents.

Maverick credits IOP as being the best thing we could have done for him. "Something about listening to other kids my age talk about their problems made me feel less alone," he said to me recently. "It helped me see how lucky I am. It inspired me to figure out a better way of handling my emotions."

It's important to note that talking openly with kids about mental health is probably the best prevention tool. "There is a perception that asking children about their suicidality can increase their suicidal thoughts," said Dr. Nguyen. "However, this perception is clinically inaccurate. A plethora of studies have demonstrated that direct inquiry destigmatizes suicidal thoughts and decreases the frequency of ideation."

Destigmatizes. That's the important piece.

"The biggest thing I hope for my patients and their families is to normalize the nature of mental health across all demographics. Mental health is indiscriminate on age, sex, gender, race, and creed. In other words, mental health [challenges] can occur in children and adolescents just as frequently as it does in adults," said Dr. Nguyen. "I encourage the caregivers of my patients to frequently provide verbal check-ins with the patient, to not only assess for change in their mental health status but to also provide a safe environment for them to feel their experiences are normalized and validated."

Carline finds that in her experience, a lot of kids' mental health crises revolve around their peers and social media.

"I hear a lot of comparison to others, high expectations, not feeling accepted and parent concerns in my office," she said. "My clients are in a unique stage of development where they are discovering independence and starting to challenge their parents' values and decisions... parents can see this and start to hover or try to control their children, [which can] further push the child into fighting their parents' values and decisions. It is such a fine line for a parent to walk each day. Remember, the parent is the expert on their child. You know when something isn't right!"

Additional Resources and Support

If you are shepherding a child through a mental health emergency, please don't overlook your own self care. Yes, that may mean going to therapy to talk about your kid going to therapy. I was so impressed with the outcome of my son's psychiatric treatment that I started seeing my own psychiatrist! GAME CHANGER. Modeling solid emotional regulation is one of the building blocks of parenthood where I was lacking, so I put in the work to improve my skills alongside my son.

Online resources for parents and caregivers include:

• The SAMHSA "For Parents and Caregivers" webpage. This page includes everything from warning signs your child may be struggling to ways you can get help.
• The Youth Mental Health Project Parental Support Network. Designed for both parents and caregivers, The Parental Support Network gives parents and caregivers the opportunity to find and support each other in a safe space. This is done via free, confidential meetings.
• The National Alliance on Mental Illness Family Members and Caregivers resource guide. Learn how to help your child and support your recovery while caring for your own wellbeing.
• The Society for Adolescent Mental Health and Medicine Mental Health Resources for Parents of Adolescents and Young Adults guide. This guide includes links to various mental health resources, both in-person and online, as well as treatment locator services.

Your child's school may also be an excellent resource. Looping in our public school's guidance counselor was instrumental in keeping Maverick safe and looked after while he was on campus. He knew there was a trusted adult he could talk to while he was at school, and I felt a teensy bit less anxious about him being out of my sight during the day.

As of this writing, my son is happy, healthy, and thriving. He's also very open about the fact that he takes daily medication, is on the autism spectrum, and struggles with anxiety and depression. I am determined to break the generations-long cycle of unaddressed mental illness in our family by sharing our experience as often as possible while destigmatizing discussions around mental health. I owe that both to myself and my children. No child should have to go through any kind of crisis alone—nor should you.

If you or a loved one are struggling with thoughts of suicide, the 988 Lifeline provides 24/7, confidential support to people in suicidal crisis or mental health-related distress.