Sometimes in fostering, things veer from ok to not ok fairly quickly. Recently, we had a mental health emergency in our home. It was not our first, and likely won’t be the last. We are well equipped to handle this as one of us is a child trauma therapist and knows all the procedures. For those families without trained professionals in the field, mental health emergencies can be scary. Armed with the right knowledge, you can be a solid, therapeutic support for your foster teen during a scary time.
A mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves, others and/or prevents them from being able to care for themselves or function effectively in the community. (NAMI, 2018).
Youth in foster care may experience a mental health emergency for a variety of reasons. It can be due to:
- medication changes/reactions,
- triggering events that re-activate trauma,
- receiving difficult news,
- on-going or newly emerging mental health concerns (mania, depression, etc),
- substance use
A youth might become suicidal, homicidal, manic, or be struggling under the influence of mood-altering substances. All of these can be dangerous for themselves or for those around them.
One of the biggest roles foster parents have is to advocate for the youth in our care. If we notice changes in behavior or mood that concern us, bringing them up to the youth and to our team is critical.
NAMI lists common signs of approaching mental health crises here:
(NAMI, 2018)
There can be challenges in noticing these symptoms in foster youth. You may not have known them long enough to know what their “normal” is. They may not trust you enough yet to share their true emotions and thoughts, and may hide things from you out of fear that their placement will disrupt if they are honest. Some foster youth are desensitized to crises, and are almost used to living in a chronic state of crisis, meaning they struggle to notice when things are abnormal.
Familiarize yourself with your foster agency’s policies and protocols.
You don’t want to be fumbling for the on-call worker’s number at 2 am and you don’t want to be on a low battery after being outside with a child who is running while trying to google what to do next. Take specific de-escalation training BEFORE an emergency ever occurs.
Have open discussions with your youth about what you would do in a mental health crisis. I teach families to rehearse this just like a fire drill or tornado drill. Help your youth understand that you view a mental health crisis as a potential event that merits immediate attention but does NOT mean they are going to be disrupted from your home. Many kids are afraid families will give up on them if they are in a mental health crisis. Don’t make promises you cannot keep but let them know these events wouldn’t be an immediate dealbreaker for you.
Familiarize yourself with local resources.
For us, we call a mobile crisis number for triage OR go to the emergency room to access the triage if the situation requires it. We also have a walk-in crisis center where you can access the triage if you are able to safely walk in with your teen. We have to notify our agency, ideally before calling crisis services if possible but sometimes that is not possible. We have options for outpatient services if the youth is stable, as well as voluntary short-term crisis stabilization (3-7 days on the unit), and acute inpatient care (often about a week) for teens who are deemed a danger to self or others, or who require medication stabilization in a contained place.
When possible, go to a children’s hospital unless your area has a general hospital that is best with behavioral health crises. Children’s hospitals tend to have an environment and staff that can help your child feel safer and may be best equipped to meet your family’s needs. If you have to be evaluated in the emergency room, I highly recommend bringing some items to make your stay more comfortable. It can take hours to days to finalize evaluation and find placement in a hospital for a child, depending on how many beds are open, the severity of the behaviors, and just how busy your emergency room is. If the ED is overwhelmed with patients or ill-equipped for mental health emergencies, they may require you to stay with the child until placement is found.
Prepare as much as possible.
I try to pack a phone charger, refillable water bottle, sweatshirt or blanket for myself, headphones, and important paperwork (I keep digital copies of all of ours). Snacks or drinks you prefer can be helpful also (our hospital vending machine WILL eat your money and not give you the food). A comfort item for the child or teen can also help, like a stuffed animal.
Be proactive in as many ways as you can!
Plan ahead. Familiarize yourself with resources. If a crisis seems likely, have a bag packed to take if needed. Equip your home with safety items that may help.
For us, these window alarms have made a big difference in our sense of safety around runaway behaviors, or even just preventing sneaking out!
What questions do you have, or what tips would you add to this brief overview?
(Brister, T. (2018.). Navigating a mental health crisis | NAMI: National Alliance on Mental … www.nami.org. https://www.nami.org/Support-Education/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis