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The importance of your resource list cannot be understated for your success! Surround yourself with support in a way that is helpful. Continue to take responsibility for what you have control over and recognize that you are the only person who can ultimately change you; however, YOU MATTER and there are many people who WANT to be a support in your journey. Take advantage of the caring individuals who want what is best for you.
IN CRISIS NOW
Identifying your local hotline is best because local resources are suggested as needed.
The National Suicide Prevention Lifeline number is 1-800-273-8255.
The National Crisis Text Line is available by texting "HOME" to 741741.
Utilize the suicide prevention phone number and text line whenever you or someone you know needs immediate support for thoughts about suicide or self-harm. If you or someone else feels unsafe, there is no need to hesitate, just reach out.
WHERE TO GO WHEN IN CRISIS
Take the person to the Emergency Department, Walk-In Clinic, or Urgent Care Center. You can call the Primary Care Provider as well. They will at times work the person in during business hours.
Identify if you have a Local Crisis Team and call them. It is likely they will meet with you where you are or at the hospital to evaluate the situation.
Identify Crisis Stabilization Units or Facilities in your area. Most require a referral for insurance to pay for the stay. They have their own evaluation criteria. If you pay cash, there is more flexibility in getting someone in for a stay. The Emergency Department will likely transfer the person in crisis to the local crisis stabilization unit.
Take the person in crisis to the local crisis stabilization unit/psychiatric hospital when they are experiencing a mental health crisis. A mental health crisis includes an imminent risk of self-harm, harm to others, or a lack of functioning. If you are unsure if the child/person is in a mental health crisis, you can call the local crisis line or National Suicide Prevention Lifeline (800-273-8255) for guidance or, to be safe, drive them to your local Emergency Department.
Some questions to ask the person in crisis to help you understand their level of risk include. If you are asking a child they must be old enough to understand what you are asking or the answers are invalid.
Are you having thoughts of harming yourself or wanting to kill yourself? (assess suicidal ideation)
Have you thought about a plan of how you would do it? (assess suicidal plan)
Do you believe you could follow the plan through? (assess suicidal intent)
Do you have the means available to carry out your plan? (Do not suggest a means. Example, if they want to overdose do they have pills available?) (assess means)
Do you think you can stay safe until tomorrow? (assess immanency)
Always err on the side of safety! Each person, family, and situation has nuances that require individual considerations, as opposed to black or white columns. However, as a general guideline, the following chart can be used to determine your course of action with your child.
Again, always err on the side of safety. If you or the person in crisis are unsure whether the current risk is imminent OR you do not feel capable of assessing the person, then call the local crisis team. If one is not available in your area, call the local or national crisis line to ask for guidance OR just drive to the local emergency department. Either way, you will gain the support you need to assess the person and give you the best options moving forward.
If your child or the person in crisis is unable or unwilling to address their mental health crisis needs voluntarily, then call your local crisis phone number. Some areas may have a mobile outreach team that can meet you where you are at and assess the situation. This will help you determine the best course of action. In some instances, as a last resort, the crisis team may recommend an involuntary commitment (invoking parens patriae) to the local crisis stabilization unit to ensure the safety of the person in crisis. If the person is agreeable, they will often ask about a voluntary stay at a stabilization center first.
The decision to invoke parens patriae and to briefly take away an individual's freedom of choice is not taken lightly. Parens patriae is only invoked if an individual is a danger to themselves. The mobile crisis team's goal is to motivate the individual to act on the individual's best behalf utilizing communication tools, not force. Law enforcement would be called to invoke parens patriae if the crisis team believed the individual's lack of mental health functioning would lead to self-harm or suicide.
No parent, loved one, or friend wants involuntary commitment for their person, but at that moment, you must do what is needed regardless of what they may want. Making decisions based on the person's needs is the most crucial and challenging aspect of the support role!
Whether or not the person voluntarily or involuntarily stays in a crisis stabilization unit or psychiatric hospital, your journey is far from over. The expectation for an inpatient stay is to stabilize the person's mental and emotional state to prepare them for outpatient therapy. Therefore, do not be surprised when your loved one is sent home with only a safety plan, a local mental health resource list, and potentially some medication. You may feel like this isn't enough and it's not! This standard discharge process has been the most considerable frustration of parents, family, and loved ones reaching out for help. For this reason, the focus is on the solution by creating your support system outside of any emergency mental health crisis. Our intensive treatment program at NCSS is perfect upon discharge! It is the process of looking at when suicide became a choice and learning to work on reframing and reworking the mental status around suicide.