It’s been months since my last post. I don’t like to give advice. Provide information and resources, sure. But giving advice about a life and death matter — that worries me. But maybe not giving advice is equally risky, so here goes.
Say you are in a town like Huntsville, Alabama, where the hospital, in spite of being the only hospital of any size for a 100 miles, and in spite of having a separate facility for women and children, and in spite of being an aggressive investor buying up other hospitals, hasn’t a single bed for a child or teen in need of emergency psychiatric intervention. What do you do?
1. You can hope that the situation at Decatur Morgan Hospital West Campus (formerly Decatur General Behavior Medicine Center) over in Morgan County where Huntsville Hospital ships its psychiatric cases that come in through the Women’s and Children’s ER (and where those ordered by the Courts for psych evaluation land) has improved. See my previous post.
Chances are good that your teen will be returned to you alive, and that is what matters most. Maybe he or she will be scared sane.
But what worries me about a teen’s first encounter with psychiatric treatment being negative is that he will never admit to being in need of help again and if he (or more likely when) he becomes suicidal again, he will make sure to choose a technique that will keep him out of such a place, one where the severely depressed are mixed in with the seriously aggressive and cut off from family and friends in a facility that is run like a detention center with little medical oversight.
2. Leave town. This is the best thing you can do, I think. First, immediately. Later, permanently.
Before you get into a crisis, check out your options. Start with teaching hospitals.
If you are in Huntsville, Alabama, you have at least two options within 100 miles (about 90 minutes): Go first to these hospitals’ ER.
- The University of Alabama in Birmingham. Child and Adolescent Psychiatry at UAB has 35 inpatient beds for evaluation and treatment.
- Vanderbilt University’s Child (4-12) and Adolescent Program (13-18). Vanderbilt has a psychiatrist (not a social worker, or salesperson, or intake coordinator) on duty 24 hours a day, 7 days a week for assessment.
How does going to a real psychiatric hospital compare to going to a freestanding quasi-detention center?
At Vanderbilt’s program,
- You can get immediate referrals and prompt evaluations for neurological assessments. There’s a lot of similarities in symptoms of conditions like Post Traumatic Stress Disorder (PTSD) and Post-Concussive Syndrome. If your teen’s suicidality followed a violent attack, you need to consider such possibilities.
- Your child sees a psychiatrist daily. You visit with the psychiatrist at the beginning and end of the child’s stay. The psychiatrist returns your phone calls. In other words, you have actual contact with the person treating your child.
- You can visit your child every day, on the ward, in his or her room or common area if the roommate’s folks are there, for an hour in the evening, and two hours (one morning, one afternoon) on weekends. You see where your child is living. You meet the nurses and the techs.
- You can have telephone contact with your child whenever you want. Or she/he can ask to call you.
- A social worker is also involved to support the psychiatrist and to help the families, especially with aftercare. You leave with an appointment set up for continuing psychiatric, neurological, and/or therapeutic care that is timely. (In contrast, expect about a month’s delay between release and your child’s first follow-up, if you have to deal with a place like Decatur Morgan Hospital West Campus.)
- Your child may not like separation from cell phone and social media (or maybe he/she will: no pressure for a while) and confinement, but chances are your child won’t emerge determined never again to seek psychiatric help.
3. Don’t assume, however, that if you don’t live near a teaching hospital, you are sunk.
Consider, for example, Asheville, NC. Its Mission Hospital has inpatient adolescent psychiatric services.
- Huntsville’s population is 182,956 people; the metro population of the five North Alabama counties making up its Combined Statistical Area is 430,734.
- Asheville has about a 100,000 fewer people: 83,393. Asheville’s metro area includes 4 counties; population, 424,858.
A question of priorities, I suppose.
Getting a suicidal person of any age a week’s stay in a psych hospital isn’t going to fix him or her forever.
The best you can hope for is that your child is
- safe long enough for the suicidal urge to pass
- learns some coping skills
- gains some insight into why he/she considered dying
- isn’t scared away from seeking help again
- gets very timely appointments with professional who will provide the support needed.
I got into this subject following the suicide of Christian Adamek (see previous post). His father is following through with his commitment to honoring his son’s life by promoting a conversation about means of improving mental health care, including “immediate access to care in the form of assessment, diagnosis, treatment and monitoring” by establishing a nonprofit organization, Little Orange Fish. There’s not much on the website yet, but there is a way to sign up for updates.
I look forward to the discussions Little Orange Fish will facilitate.