Psychiatric hospitalizations are stressful and the whole family is in crisis when it happens. It is something that no family makes an active plan for because we don't want to think about the difficulty of a mental health crisis. No one gets up in the morning and says, "I think my child is going to commit suicide today." But it does happen, and every family needs to develop a crisis plan for medical and mental health emergencies alike. It can help the family navigate through a really difficult crisis.
Parenting a child who has challenging behaviors is a really tough thing. Many parents who share this journey will tell you that life is no longer Black and White. Our lives and our challenges get very grey. When a child routinely throws objects, breaks things and threatens, how do you know when it is time to seek a hospitalization for your child? How do you know if the ranting and screaming is psychosis or if it is behavioral?
It's really important to note that psychiatric hospitalization programs are meant to be short term stabilization programs. The staff there does not know your child, and will not create a meaningful plan for your family. It is basically a holding pattern for a child: a safe place where that child will be watched against self harm and harm to others. It's not a solution for your child, it is a safety valve.
Here are some considerations on the decision to seek a hospitalization for your child.
When to GO to the hospital:
The child is a DANGER TO SELF. The child is actively hurting themselves. Does the child have a plan? It is not enough for a child to be threatening suicide. The child who requires hospitalization will have a plan and the ability to follow through on it. You know your child best, and you usually know when it is an emotional threat only.
Child is ENDANGERING OTHERS. A child who is out of control and is actively threatening bodily harm to others may be a candidate for hospitalization. This can look different to each parent, but the behavior has to be truly dangerous to others. (Think "throwing chairs at people" vs "throwing toys that could hurt if struck")
If the child is out of control, call 911 emergency services. Placing a child in a car that is in psychosis can cause an accident. Few parents are calm enough to safely transport a child who is in crisis. The ambulance is the safest place for a child being transported to the hospital. If your County has one, consider calling your County's Crisis Intervention Program to help facilitate a hospitalization.
Considerations before you leave your home:
Insurance: Check out your benefits coverage and requirements for inpatient and outpatient care and providers. Investigate the costs of out of network providers which may be needed. This research needs to be done early and included in the crisis plan.
Know where the providers are located. There are limited numbers of hospitals that have Pediatric Psychiatric Units. This will lessen the numbers of transitions in the hospitalization process.
There is NO GUARANTEE that the child will be admitted, especially if the child is calm and lucid upon arrival. This is extremely frustrating as the decision to attempt hospitalization is difficult for the family.
There is no guarantee of stay at the hospital. 3-5 days is average, but the child may be released earlier or later. This makes planning difficult.
Admission to the hospital may not change the child's situation. It may even make the situation worse in some cases.
Medications may not be modified during the hospital stay. This can be very frustrating if this is the parent's expectation. Alternatively, a medication change or addition may be recommended to the parent's surprise.
Outpatient psychiatrists do not have hospital rights. This means that even if the child's psychiatrist recommends a hospitalization, this does not guarantee the child will be admitted.
Plan to spend hours at admittance. This is a slow process and there is a high chance that there will not be a bed available. Families at minimum will spend 4-5 hours at admittance, and it can take over 24 hours if the child meets the hospitalization criteria and must wait for an opening.
Limited availability of pediatric psychiatric beds translates to fewer intakes. If admitted, your child may be transported to a hospital that has an open bed and may be located hours away.
Hopefully, this will help you understand the complex process of hospitalization. You can find more interesting and helpful articles at www.toolboxparent.com
Note: This article was sponsored by the Adopt America Network and was written by Deb Fjeld.