Mental Health Emergency Services for Teens: What to Do When Your Community Fails You

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.

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.

6 thoughts on “Mental Health Emergency Services for Teens: What to Do When Your Community Fails You”

  1. So sorry to hear you are going through this. I think it is hard or impossible once the child is at H’vlle ER to keep them out of Decatur if they have been brought in by EMS. If not, if you are taking them in more or less with their agreement, go directly to Vanderbilt would be my advice.

    I don’t know — I certainly never could find — what a parent’s or child’s rights are, and having rights doesn’t mean they are going to be respected without a court getting involved.

    I could never get anyone to explain to me why a 14-year-old had to consent in writing to a voluntary admit but then could not say this admit is done. Makes no sense to say you have to consent to entry and but have no say in exiting.

    I wish I could help you, I really do. Maybe Decatur has changed; I don’t know. Maybe the insurance companies have found out how little actual professional psychiatry goes on that they are undoubtedly billed for. I’ve never seen an itemized bill from one of those places — I wonder if anyone has. There’s probably some scheme where the patient would have to request but since the patient is a minor couldn’t receive it. I don’t know. Would be interesting — but again, no way of finding anything out, no way — and certainly not for outsider.

    I never understood or needed to know all the details of this or any of the situations I’ve heard about. I know of one young girl who has been on the streets of Miami for 2 years (now 16) after DHS essentially broke up her family, and it has nearly killed her grandmother (a friend of my late parents’). It’s a national disgrace, really. I’ve helped her with writing letter after letter (grandparents have few rights in Florida) — impossible to find who is even in charge. Done no good.

    I can only say that the child I wrote about 4 or 5 years ago is now a very healthy, responsible, strong, and compassionate nursing student. She still, however, will not set foot in the state of Alabama and so hasn’t some of her family for years.

    She told last time we talked she is grateful her parents never gave up.

    So for your niece. It sounds like she has her parents’ support — and her aunt’s, too. That’s critical.

  2. Hello,
    I came across your blog while searching for information as my niece was placed at Decatur a couple of days ago. Her placement there followed the path you laid out as my sister took her to Huntsville ER. Then eval and then transfer to Decatur for estimated 7 day in-patient. Question: do you know if there is a way to have them transferred to UAB or Vanderbilt once at Decatur? Also, are there any resources to guide parents on their rights during psychiatric treatment of their child? My sister is looking for all possible information as this is the first time going through the process. Prior to this my niece had been in counseling but confided recent self-harm to her parents. Any additional information would be much appreciated. And, thank you for sharing your story and posting, M

  3. The CASA is different from the court-appointed attorney, in case I wasn’t clear about that. While the CASA’s training may give him a different view of what it is the best interest for the child than the child’s own desires, the CASA is the one who is most likely to take his desires into consideration in making a recommendation to the Court. An attorney must focus primarily on legal status, but the CASA can provide some sense to the Court of the child’s emotional and social needs.

    Basically, you need to get as many people on his team as you can — and just hope that the parents don’t exclude you from contact with the child (even grandparents’ rights to work on behalf of the child are limited if the custodial parent objects). Very messed up situation. A lot depends on the Judge.

  4. Thank you for the reply. The court appointed atty for my nephew better pack a lunch….If I have to call fox 6, the atty general etc I’m willing to do it. Thanks again : )

  5. This is an old post, and maybe things have changed. I don’t think the Decatur place is set up for long-term care. I can readily imagine there is probably even a worse place for long-term psych care for youth — or maybe they are lumped in with adults.

    It sounds as if the mother’s parental rights should have been terminated, and the father’s too if he weren’t willing to raise his child.

    That would send the boy into the foster care system (unless a relative stepped in and was approved) — and who knows if that would be better or worse.

    And you are right: kids don’t just wake up this way one morning. It took 14 years to get to where he is today, and it is going to take at least as long to unlearn what he has been taught, I fear,

    If he does go into care, his one chance might be if he has a dedicated GAL (guardian ad litim) or CASA (court appointed special advocate). These are volunteers (and hence do not have the caseload of social workers) who are charged with making recommendations on behalf of child’s best interest and keeping an eye out that court mandated actions (tutoring, counseling) actually occur. The CASA or GAL office has attorneys and on paper at least a child can ask to consult with one, as well as to be present at court hearings and to speak to the judge on his own behalf. In theory. See: What the child has a right to and what he gets can be two very different things, but if he knows his rights, he has a bit better chance than if not. Maybe.

  6. I’m not sure how old this post is, but I read the previous post as well…..My nephew has been hauled away to Decatur. We all knew my nephew had problems from a early age, and my sister, a.k.a Mother of the Year, refused to have him assessed…..sounds like neglect huh? All because SHE WAS TOO EMBARRASSED, never mind the fact that it was NEVER about her in the first place. A parent will always put their needs last, when it concerns their child. Or, they are suppose to right? Now that she has a new man in her life, she is embarrassed of him and will not even bring him around the new man or his family….because she is embarrassed of the monster she created. Understand this…my nephew did not just wake up yesterday morning like he is….he has gotten progressively worse, relentless anger issues ( towards women, assuming it’s bc of his mother), addicted to porn, has a form of ocd and other issues. Now that things have gotten rough, due to the fact he is 14, 225lbs, and almost 6 foot, she wants to wash her hands of him. She has tried to have him sent to homes, been to one hospital above UAB and at UAB also. She would not go pick this kids up from UAB! UAB had to threaten her with abandonment and she still didn’t pick him up. His dad finally went after DHR called him. My nephew was only home on day two and she tried everything to get him somewhere. As I am typing this, he is in route to this place. She sounded delighted when explaing all of this to my parents….I hope, someone reading this has thought, why would the state of Alabama allow this trash to go on, and they know she abandoned him at home for a month, no food, no clean clothes….way to go DHR! Oh, sorry for my rant, just don’t understand how this is ok, and even tolerated.
    This fella can’t even tie his own shoes, can only read on a first grade level, and eats all foods with his hands. A PRODUCT OF HIS RAISING AND ENVIRONMENT. THANK YOU FOR THE INSIGHT ON THIS PLACE, the nephews attorney, which is a joke, because they don’t do ANYTHING for the kids, will have me to deal with everyday until I feel she is being proactive and trying to help him.

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