Moment of Crisis, Part 3/4

Parenting with hope through the hard places by Jennifer Griffis.

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“I don’t think she can safely return home right now. Do you have any other options? Are there any family members who can take her?”

My husband and I sat across from our daughter’s case manager as she continued, “I just don’t think she can safely come home. The risk is too high.”

This was supposed to be a treatment plan meeting. Our daughter had been home from residential care for almost six months. Already we could feel her behaviors beginning to escalate. We needed more support, so we scheduled a meeting with the case manager. But before the meeting happened our family experienced a crisis. We could no longer safely manage our daughter’s behaviors at home and she was admitted to the psychiatric hospital.

Her treatment team was supportive of a residential care placement. She met the criteria for medical necessity. While our hearts wanted her to be home with us and her siblings, we knew this was the best treatment option for her at this time.

As the meeting continued we learned that even with treatment team support our state’s funding approval process would take 6-8 weeks. And if it was initially denied (which often happened) the process would take even longer. The behaviors that initiated the crisis had been extreme, and the amount of trauma inflicted on all of the children was significant. Members of the treatment team agreed that it wasn’t safe to have all of them together until we’d had the opportunity for intensive therapy.

Our daughter was going to be discharged from the hospital in a few days. The system had no options to help us reduce the risk of another crisis and no options for a short-term placement. In the knowledge of that reality we made the difficult decision to send the rest of our children to stay with family while we worked to manage behaviors, fill out applications, and attempt to avoid another crisis-related hospitalization.

It was a long seven weeks for all of us.

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Families walking through a mental health crisis often face similar challenges. Here are a few of the most common:

A visit to the local emergency room is often the recommended crisis option. While many families have access to a crisis hotline through their behavioral health agency or treatment provider, few communities actually have a full array of crisis services. When parents don’t have access to services such as crisis stabilization or crisis respite, they often end up in the local emergency room. When it has been well-equipped as part of a larger mental health crisis support system, an emergency room can be effective option. Unfortunately many families head to the emergency room during a mental health crisis because they have been told it is their only option, not because it is the best option.

Experiencing a mental health crisis sometimes feels like a requirement to get into higher levels of service. Parents and providers can often tell when a child or youth is showing signs that they need a higher level of support. Typically these signs are subtle at first and may be difficult to document to others outside of the child’s direct treatment team. Many parents feel like it takes a crisis before the system responds to their request for additional services. The use of a tool such as the CANS can help increase communication about even a subtle shift in the needs of a child or youth and help avoid a crisis.

The system response to a crisis is slow or nonexistent. A crisis signals that a shift in services is needed. Maybe the frequency of a service needs to be increased or a different array of services is required to meet the current needs of a child. In order to effectively respond to a crisis this shift needs to be immediate, but systems are rarely designed to move quickly, especially when it comes to approving funding for additional services. The reality for many families is that the risk of another crisis increases when approval procedures within a system are too slow.

In order for systems to deal with crisis well they need tools to identify families at risk of experiencing a mental health crisis, accessible crisis support services, and timely access to appropriate treatment services after a crisis. For those parents navigating systems that are still creating effective mental health crisis services, there are ways to help support your child in a crisis, even if the system falls short.

• Know what will determine a “crisis” for your family. The exact situation that defines a crisis is unique for each family. It may be influenced by job responsibilities of parents, ages and emotional needs of the siblings, availability of system resources, the behaviors of the child, and many other factors. It’s also important to remember that your definition of crisis will change over the years as family situations shift and as children grow and mature.
• Follow the current crisis procedures, even if they include options you might like to avoid, such as a trip to the emergency room or calling law enforcement for support. It’s also a good idea to educate yourself about your rights and your child’s rights within each system before a crisis occurs. Utilizing the current crisis system and being willing to share your experiences with others can help move a transitioning system toward more effective crisis services.
• Have backup plans to deal with the aftermath of a crisis and the slow timelines that often exist for systems in transition. These plans might include support from extended family members, community services that fall outside the mental health system, or creative solutions based on your family’s unique strengths.

An effective system of care views a crisis as an informing experience, a time to learn more about a child or youth and respond in a way that reduces the risk of another crisis. A family supported during a crisis is also likely to develop trust in the system, which strengthens relationships between all system partners, creating a stronger more effective system for children, youth, and their families.

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