Tessa Quinn
When a minor is experiencing suicidal thoughts or behaviours, it is important to seek immediate support. This can involve calling a helpline, such as 988, or contacting a local hospital or emergency room. Hospitals are equipped to provide mental health evaluations and suicide risk assessments to determine the appropriate treatment, which may include inpatient or outpatient services. Inpatient hospitalization aims to stabilize the minor and ensure their safety, while outpatient treatment involves weekly therapy and group meetings. The treatment plan will depend on various factors, including the minor's personal history, current mental state, home environment, and specific suicidal thoughts or behaviours. It is important for families to be involved in the treatment process, and hospitals will often work with them to create a discharge and aftercare plan.
| Characteristics | Values |
|---|---|
| Goal of doctors at the ER | To assess the child’s safety and outline next steps |
| Child has thoughts about suicide but hasn’t made a plan or an attempt | Sent home with a referral for outpatient treatment |
| Child has a plan for suicide or has made an attempt | Sent for inpatient treatment at a hospital until doctors think it is safe for them to go home |
| Risk factors considered by doctors | Impulsivity, recent pattern of behavior, and known triggers in the home or school environment |
| Child has ideas about self-harm but no firm plans | More concerning than vague thoughts of suicide |
| Child has a plan for suicide or harm to others, has made an attempt, or is acting in a highly impulsive manner | Hospitalization is almost always required |
| Tools used by ED providers | Suicide Assessment Five-step Evaluation and Triage (SAFE-T) |
| Purpose of inpatient hospitalization | To stabilize and get the patient out so that they can get the true treatment they need |
| Partial hospitalization program (PHP) | Outpatient day treatment where the patient is there for 6+ hours every day or every weekday |
| Intensive Outpatient Program (IOP) | 3-4 hours, 3-4 times a week, at night or in the afternoon |
| Inpatient hospitalization | To keep the patient safe and stabilize them |
| Hospital inpatient care | Specialized inpatient units for someone who is medically compromised and needs urgent medical attention for a mental health crisis |
| Residential treatment facilities | Care outside of a hospital or medical facility, often for drug and alcohol rehabilitation |
| Length of stay at psychiatric hospital | Different for each child, typically 4 to 6 days |
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What You'll Learn
Risk assessment and triage
When a minor presents with suicidal ideation or behaviour, healthcare professionals will conduct a comprehensive risk assessment to determine the best course of action. This assessment will consider various factors, including the minor's personal history, current mental state, home environment, and specific suicidal thoughts or behaviours. It is important to note that risk assessment is not an exact science, and each case must be evaluated individually.
One tool commonly used in risk assessment and triage is the Suicide Assessment Five-step Evaluation and Triage (SAFE-T). This tool guides healthcare providers through a step-by-step evaluation of the minor's risk factors, protective factors, and suicidal thoughts or plans. It is designed to help estimate the overall risk and determine the appropriate level of care. The SAFE-T tool is available as a pocket card and a smartphone application, making it easily accessible to healthcare providers.
During the triage process, healthcare providers will also consider the minor's impulsivity, recent patterns of behaviour, and any known triggers in their environment that could lead to a crisis. If the minor has a plan for suicide or has made an attempt, hospitalization is often required to ensure their safety. However, if they have no plan or intent, no prior suicide attempts, and no history of mental illness or substance abuse, they may be managed as outpatient and referred for further evaluation and treatment.
In some cases, brief ED interventions may be recommended, even if the minor is discharged home. These interventions aim to help minors develop skills to recognize and cope with suicidal thoughts and create action plans to make their environment safer. Additionally, counselling may be provided to address safe gun storage and remove access to firearms temporarily, as guns are associated with a high suicide case-fatality rate.
Overall, risk assessment and triage for suicidal minors involve a comprehensive evaluation of their risk factors and protective factors to determine the appropriate level of care. The process aims to ensure the minor's safety and provide them with the necessary support and treatment to address their suicidal ideation and behaviour.
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Inpatient vs. outpatient treatment
If a minor is experiencing suicidal thoughts or behaviours, they can be taken to the emergency department of a hospital for assessment and treatment. Here, doctors will assess the child's safety and outline the next steps. If the minor has no suicide plan or intent, no prior suicide attempt, no history of mental illness or substance abuse, and no agitation or irritability, they will likely be discharged with a referral for outpatient treatment.
Outpatient treatment typically involves weekly therapy, psychiatry, or group meetings. Partial hospitalization treatment, for instance, is an outpatient day treatment where the patient attends for 6+ hours every day or every weekday. This can include 1:1 therapy, psychiatry, group therapy, psycho-educational groups, and recreational/expression therapy. Intensive Outpatient Programs (IOP) are shorter, at 3-4 hours, and occur 3-4 times a week.
If a minor has a plan for suicide or has made an attempt, inpatient treatment is often required. Inpatient hospitalization provides 24/7 acute care and support, with the patient spending days and nights in the facility. This could be in a regular hospital or a freestanding psychiatric hospital. The average length of stay is 5-7 days but varies depending on the patient's progress. Inpatient treatment can be scary for minors, as it involves leaving everything and everyone they know, but it can also be life-saving. It provides a safe space for the patient to stabilize and learn skills to cope with suicidal thoughts.
In both inpatient and outpatient settings, the patient will undergo a suicide risk assessment to determine the appropriate treatment. This assessment considers the patient's personal history, current mental state, home environment, and specific suicidal thoughts or behaviours. Brief interventions during inpatient stays can be therapeutic and help prevent future self-harm. These interventions focus on developing skills to recognize and cope with suicidal thoughts and creating action plans to make their environment safer.
It is important to note that risk assessment is not an exact science, and each case must be evaluated individually. If a minor is expressing suicidal thoughts or intentions, it is crucial to seek professional help immediately to ensure their safety.
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Stabilisation and discharge
The primary goal of doctors in the emergency department is to assess the safety of the minor and outline the next steps. If the minor has no suicide plan, no prior suicide attempt, no history of mental illness or substance abuse, and no agitation or irritability, they will likely be discharged with a referral for outpatient treatment. Outpatient treatment typically involves weekly therapy/psychiatry/group meetings. Partial hospitalization treatment, a form of outpatient treatment, involves spending 6+ hours daily or on weekdays at a hospital, behavioural health clinic, or mental health care centre. Intensive Outpatient Programs are usually 3-4 hours long, 3-4 times a week, and can be easily combined with school or work.
If the minor has a plan for suicide or has made an attempt, they will likely be admitted to inpatient treatment at a hospital until doctors deem it safe for them to be discharged. Inpatient treatment is meant to stabilise the minor and ensure their safety. It is not a cure, but rather a lower level of care that prepares the minor for further treatment in their community. During inpatient treatment, minors may participate in activities such as art therapy, music, sports, and socialising with peers. The length of stay varies depending on the individual's needs.
Once the minor has been stabilised and is ready for discharge, the treatment team will work with the family to create a discharge and aftercare plan, which may include follow-up appointments and continued therapy. The family will be given time for goodbyes before the minor is discharged, equipped with the skills and resources to continue their treatment journey.
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Mental health evaluations
When a minor presents to the emergency department with suicidal ideation or behaviour, a mental health professional is typically consulted to conduct a suicide risk assessment. This assessment considers various factors, including the minor's current mental state, personal history, home environment, and specific suicidal thoughts or plans. The assessment also takes into account any prior suicide attempts, history of mental illness or substance abuse, and the presence of agitation or irritability.
The results of the mental health evaluation will determine the next steps in the minor's care. If the minor is deemed to be at low risk, they may be discharged home with a referral for outpatient treatment, which can include therapy, psychiatry, and group meetings. Outpatient treatment aims to provide ongoing support and help minors develop skills to manage their thoughts and emotions effectively.
However, if the minor is assessed to be at a higher risk, inpatient hospitalization may be recommended. Inpatient care is typically short-term and focuses on stabilization and ensuring the minor's safety. It provides a higher level of supervision and intensive treatment, which may include individual therapy, group therapy, and recreational therapy. Inpatient hospitalization can be a scary experience, but it is often necessary to ensure the minor's well-being and provide them with the intensive support they need.
During the mental health evaluation, the minor's family may also be involved in the process. This involvement can include providing information about the minor's home environment and support system, as well as participating in the creation of a discharge and aftercare plan. It is important for hospitals to work collaboratively with the minor's family to ensure a smooth transition back to the community and continued support for the minor's mental health journey.
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Next steps and follow-up care
The next steps and follow-up care for suicidal minors will vary on a case-by-case basis. If a minor has no suicide plan or intent, no prior suicide attempt, no history of significant mental illness or substance abuse, and no agitation or irritability, they may be discharged home without a mental health consultation. However, if the minor has a plan for suicide, has made an attempt, or is acting in a highly impulsive manner that makes an attempt likely, hospitalization is almost always required.
If hospitalization is required, the minor will be admitted to a psychiatric hospital or unit for assessment and treatment. The length of stay will depend on the individual's needs, typically ranging from 4 to 6 days for inpatient care. During this time, the treatment team will work to stabilize the minor and address any immediate concerns. This may include individual therapy, group therapy, recreational therapy, and medication management. The goal is to provide the minor with the skills, support, and resources they need to continue treatment and recover.
Following hospitalization, the minor will typically be transitioned to a lower level of care, such as outpatient treatment or a partial hospitalization program (PHP). Outpatient treatment involves weekly therapy, psychiatry, or group meetings, while PHP is a day treatment program where the individual attends treatment during the day but returns home at night. Intensive Outpatient Programs (IOP) are also an option, offering more intensive care than weekly therapy without the need for inpatient hospitalization.
It is important for the minor's family or support system to be involved in the treatment process and to coordinate follow-up care. This may include creating a discharge/aftercare plan, identifying triggers and warning signs, and establishing a safety plan to prevent future crises. The family or caregivers should also be aware of the resources available in their community, such as support groups, therapy, or other mental health services.
In some cases, residential treatment facilities may be recommended if additional support is needed after hospitalization. These facilities provide care outside of a hospital setting, often focusing on drug and alcohol rehabilitation or other specialized programs. The goal of follow-up care is to ensure the minor's continued stability and to provide ongoing support to prevent future crises and promote long-term recovery.
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Frequently asked questions
Doctors will assess the child's safety and outline the next steps. If the child has no suicide plan or intent, no prior suicide attempt, no history of mental illness or substance abuse, and no agitation or irritability, they will likely be sent home with a referral for outpatient treatment. If they have a plan or have made an attempt, they will likely be sent for inpatient treatment until doctors deem it safe for them to return home.
Inpatient treatment is short-term hospital care for individuals who need urgent medical attention for a mental health crisis. The goal is to stabilize the patient and get them to a lower level of care where they can receive true treatment. Inpatient treatment usually involves 1:1 therapy, psychiatry, group therapy, psycho-educational groups, and recreational/expression therapy.
Outpatient treatment is weekly therapy/psychiatry/group meetings. It can be done as an Intensive Outpatient Program (IOP), which is 3-4 hours 3-4 times a week, or as a Partial Hospitalization Program (PHP), which is 6+ hours every day or weekday.
The process typically starts with a phone call from a parent or guardian or as a referral from another healthcare organization. Once the child is admitted, the treatment team works with the family to create a discharge/aftercare plan and coordinate follow-up care. The length of stay depends on the child's individual treatment needs.
