Crisis Continuum of Care
Is your child in crisis? We
guide you through the most
common steps of this period.

Below you will find common steps to take during a crisis, but remember that every path will differ. This may be a frightening and overwhelming time as you navigate a whole new world full of unknowns. Your child may stabilize after a crisis and be able to come home. Others may benefit from more long- term treatment options after the immediate crisis is resolved.

We have resources to help you through either path on your journey.

Are you concerned about your child’s safety?

Self-Referral

If you believe your child needs immediate support and cannot wait for a visit with a therapist, you can call local crisis lines. They will walk you through the next steps and determine what is available in your area or seek out a Crisis Stabilization Unit (not all counties have one).
To quickly find crisis services contact numbers and information, you can search “adolescent crisis services” online. If your child is actively considering suicide and you are concerned for their safety, go directly to the emergency department where your child will be assessed for an involuntary hold (commonly referred to as a “5150”). If this is the case and they determine it is necessary, the hospital will not release your child until they believe the crisis has resolved. For more information on an involuntary hold, see our FAQs below.

If you call 911

In some cases, you will need to call 911. Just be aware that if you call 911 from your home, dispatch may send police to your home for support. It is important to inform them that there is no danger to others, no weapons in the home etc. (unless you have them). Police will typically call paramedics to transport your child to the emergency department for evaluation of 5585. For more information on 5585 evaluations, please see our FAQ’s below.
If your child discloses to school staff or a school counselor the intent to attempt suicide, law enforcement may be called to school where a similar process will occur.

Assessment and stabilization

Initial Assessment

Either at the hospital or with at a Crisis Stabilization Unit (CSU) facility, your child will typically be evaluated by a mental health professional who will determine if your child needs to be transferred to an adolescent psychiatric inpatient unit (this is in a hospital setting). This process is the same should you self-present at the emergency department or local CSU.

Admission to Psychiatric Unit

If your child is deemed a danger to themselves, others, or present gravely disabled (not functioning normally), they will be admitted to an adolescent psychiatric unit in a hospital. If there are no beds in your area, they may recommend moving your child to another county.
Many youth will stay no more than 72 hours; others will need to extend for longer-term treatment. An evaluation needs to be completed for each extension and must involve caregiver input. See our FAQ section on Crisis Care for more information.

Assessment and stabilization

Low Acuity

Low acuity is a medical term used to describe less severe conditions. Youth and adolescents can experience shorter intervals of emotional intensity — or highs and lows. Your child may be able to stabilize by talking to a mental health professional and return home the same day. In this case, they will likely be discharged with a safety plan outlining crisis numbers and recommendations.

High Acuity

High Acuity is used to describe people who may require more medical attention. After being admitted to a psychiatric unit, your child will be evaluated in consultation with you as the parents/guardians. Typically, medications may be recommended and started or adjusted if medications are already in use. Your child will also participate in individual and group therapy.

Discharge and Next Steps

Getting Ready to Leave

Once your child has stabilized and you feel comfortable with them returning home, you should be assigned a discharge social worker to support you with the transition home. They will help you with referrals to therapy and support services like partial hospitalization programs (PHP), intensive outpatient programs (IOP), and options for individual and family therapy. If you were not offered a discharge social worker, we recommend requesting one to assist you.

Short Term Residential Treatment

Options

In some cases, your child may not be ready to come home but will be ready to leave the hospital. At this point you may want to consider short-term crisis residential or other out-of-home services. These programs are similar to the longer stay residential treatment programs but provide treatment and teach skills in a shorter time frame, ranging from 2-4 weeks and usually up to 3 months.
Short-term residential treatment may sometimes be used as an intervention to prevent a full-blown crisis, provide further support post hospitalization, or provide an interim intervention between programs.

Are you concerned about your child’s safety?

Self-Referral

If you believe your child needs immediate support and cannot wait for a visit with a therapist, you can call local crisis lines. They will walk you through the next steps and determine what is available in your area or seek out a Crisis Stabilization Unit (not all counties have one).
To quickly find crisis services contact numbers and information, you can search “adolescent crisis services” online. If your child is actively considering suicide and you are concerned for their safety, go directly to the emergency department where your child will be assessed for an involuntary hold (commonly referred to as a “5150”). If this is the case and they determine it is necessary, the hospital will not release your child until they believe the crisis has resolved. For more information on an involuntary hold, see our FAQs below.

If you call 911

In some cases, you will need to call 911. Just be aware that if you call 911 from your home, dispatch may send police to your home for support. It is important to inform them that there is no danger to others, no weapons in the home etc. (unless you have them). Police will typically call paramedics to transport your child to the emergency department for evaluation of 5585. For more information on 5585 evaluations, please see our FAQ’s below.
If your child discloses to school staff or a school counselor the intent to attempt suicide, law enforcement may be called to school where a similar process will occur.

Assessment 
and stabilization

Initial Assessment

Either at the hospital or with at a Crisis Stabilization Unit (CSU) facility, your child will typically be evaluated by a mental health professional who will determine if your child needs to be transferred to an adolescent psychiatric inpatient unit (this is in a hospital setting). This process is the same should you self-present at the emergency department or local CSU.

Admission to Psychiatric Unit

If your child is deemed a danger to themselves, others, or present gravely disabled (not functioning normally), they will be admitted to an adolescent psychiatric unit in a hospital. If there are no beds in your area, they may recommend moving your child to another county.
Many youth will stay no more than 72 hours; others will need to extend for longer-term treatment. An evaluation needs to be completed for each extension and must involve caregiver input. See our FAQ section on Crisis Care for more information.

Short Term 
Treatment

Low Acuity

Low acuity is a medical term used to describe less severe conditions. Youth and adolescents can experience shorter intervals of emotional intensity — or highs and lows. Your child may be able to stabilize by talking to a mental health professional and return home the same day. In this case, they will likely be discharged with a safety plan outlining crisis numbers and recommendations.

High Acuity

High Acuity is used to describe people who may require more medical attention. After being admitted to a psychiatric unit, your child will be evaluated in consultation with you as the parents/guardians. Typically, medications may be recommended and started or adjusted if medications are already in use. Your child will also participate in individual and group therapy.

Discharge and 
Next Steps

Getting Ready to Leave

Low acuity is a medical term used to describe less severe conditions. Youth and adolescents can experience shorter intervals of emotional intensity — or highs and lows. Your child may be able to stabilize by talking to a mental health professional and return home the same day. In this case, they will likely be discharged with a safety plan outlining crisis numbers and recommendations.
High Acuity is used to describe people who may require more medical attention. After being admitted to a psychiatric unit, your child will be evaluated in consultation with you as the parents/guardians. Typically, medications may be recommended and started or adjusted if medications are already in use. Your child will also participate in individual and group therapy.

Short Term Residential Treatment

Options

In some cases, your child may not be ready to come home but will be ready to leave the hospital. At this point you may want to consider short-term crisis residential or other out-of-home services. These programs are similar to the longer stay residential treatment programs but provide treatment and teach skills in a shorter time frame, ranging from 2-4 weeks and usually up to 3 months.
Short-term residential treatment may sometimes be used as an intervention to prevent a full-blown crisis, provide further support post hospitalization, or provide an interim intervention between programs.

Q & A

Emergency Room Visits

Sometimes, you have no choice other than to take your child to the hospital or to call 911 and have them transported. It may be necessary for your child’s safety, but, needless to say, it is a scary and difficult process for children and parents.   When you arrive at the hospital, you should enter the emergency department just like you would for any injury or medical situation. (Some hospitals have a separate area with a phone by the entrance; you pick up the phone and explain you have arrived with your child and explain the main problem: “My child told me tonight she is thinking about killing herself and I do not think he/she/they is safe.”)  Once inside, you will walk up to the intake staff and explain the situation. Unless your child’s condition requires immediate, urgent medical care, as with any other visit to the ER, you will most likely need to wait to speak with a nurse. When you and your child are called back, your child will be asked to describe how they are feeling and answer routine questions from the nurse to rule out any medical concerns. You will then typically wait to speak with the appropriate specialist.  
The number of emergency room (ER) staff can be unpredictable; if you have the ability to search for the ER number, you can call ahead and ask for a charge nurse and let them know you are coming in. This will not necessarily expedite the intake process when you arrive, but it can help by establishing a point of contact and giving you a chance to ask basic questions. (where do I go? who do I ask for? etc.) It also helps the hospital staff prepare for your arrival.

This process can move quickly or it can take 4-6 hours or more. Depending on where you are in the country, and which hospital, you may speak with a doctor, a social worker, or with a trained member of the county Mobile Crisis team. It is important to ask for names, credentials, and contact info should you want to follow up on anything.

 

If you are worried about the immediate safety of your child,  express your concerns if you are not comfortable taking your child home. Hospital teams will likely want to return your child home and avoid inpatient hospitalization if possible, but there are times it is necessary. Be clear why you are concerned and what you would like to see happen. The same is true for the reverse: if you are looking for support and resources and do not feel an in-patient stay is necessary, be clear that this is all you are looking for.  If you brought your child to the ER but you believe they are fine to go home, the hospital may disagree with you – they may, based on their own assessment, place your child on a “5150” hold (See below for more information on this hold).  Be aware that this declaration transitions the temporary legal custody of your child to the hospital and you do not have the right to overrule that decision.

You should bring your identification and medical insurance cards for yourself and your child. In addition, bring any items you may need like medications, snacks (and water!), and materials to keep you and your child occupied. If you bring any electronics, make sure to remember the chargers.

Welfare and Institution Codes, known as WIC codes, may vary by state. These codes contain state statutes that establish programs and public social services for promoting the public welfare. In California for example, there are 20 separate Divisions.  

 

A “5150” is the adult WIC code for a psychiatric involuntary detention. It outlines how long a person can be detained (up to 72 hours). This code also establishes who can write a hold, what conditions must be met to qualify a person, the process of evaluation, the legal rights of the individual, and more. 

 

For all youth under 18, the code is technically a “5585” but you may never hear this number as police, EMT/Fire, and medical personnel usually refer to a psychiatric hold for any age as a “5150.” The actual criteria for youth is different from adults and youth should be assessed using the proper criteria. For the remainder of the FAQ, we will refer to it as a 5150 in the attempt to minimize confusion.

 

A “5250” is the WIC code that establishes a person meets the need for longer detention beyond the 5150 and extends the hold for 14 days to 2 weeks. For this to happen, the patient must be assessed by a credentialed professional (doctor, therapist etc.). A 5250 does not necessarily mean the patient will remain in the hospital for the entire 14 days.

Once your child is placed on an involuntary hold, it is extremely difficult to get reversed; hospital staff will begin calling adolescent psychiatric inpatient units to present your child’s case and seek acceptance to transfer your child to their hospital. Usually the only time a hospital will consider “lifting the hold,” (meaning removing the designation and allowing you to leave with your child), is if your child has been at the hospital for more than 24 hours, the hospital is struggling to find an inpatient bed, and/or they believe your child is doing better. At this point, staff should be speaking with you about a safety plan and possible referrals for support services. Again, it is incredibly important to share how you are feeling and what you believe is best for your child. You are the best advocate for your child and you know your child best. Staff should be informing you and including you throughout the entire process, but they get busy and are trying to make the best decisions they can with limited knowledge.

Because you will be arriving at the emergency department, you will likely not get a private room. This process can lack privacy and in our experience, is very difficult. The hustle and bustle of an emergency department can be overwhelming for you and your child. You will be directed to a bed/gurney behind a curtain where you will wait and speak to hospital personnel. At times, unfortunately, when a hospital is particularly busy, your child may end up waiting for a bed on a gurney in a hallway or even sitting in a spare chair. If your child is placed on an involuntary hold (e.g. the hospital deems them a danger to themselves or to others, or gravely disabled), they typically will be moved to a separate room where a security officer will have them in line of sight. The room will be intentionally stark for safety with limited access to items. Things like access to ipads, games etc. will depend on the hospital. It can get boring quickly.  It can be helpful to bring magazines, cards or other like items to help pass the time.

Unfortunately, whether or not insurance will cover a visit and/or hold depends on your insurance company and plan. Typically you will pay, at a minimum, the emergency department visit co-pay. The hospital may want to run tests if they believe there may be an underlying medical issue. You may want to call your insurance provider and determine these costs before a crisis arises to inform yourself of options and know what to expect.

 

With respect to ambulance transport, whether insurance will cover it will depend on your insurance plan. If you disagree with the charges, you are welcome to dispute this with your insurance company. There are also companies that you can pay to argue on your behalf with your insurance company.  

Inpatient Stay

Your child may stay the duration of the involuntary hold (72 hours) and be discharged home. Other times, your child may need more time and stay up to another 14 days.



Your child will participate in programming while in the hospital and be in a locked unit. You will be able to speak to them by phone during their stay and visit during specified hours. This will be explained to you by the hospital nursing and social worker team. You will not be allowed to stay with them the whole stay or overnight. 

These situations are difficult and stressful for the whole family. It can be even more difficult when you and your partner do not agree on what is right for your child. Unless one parent has sole legal custody, you will need to work together to come to a joint decision. As best you can, try to focus on placing the needs of your child and their safety first. Help each other return to this focus if you begin fighting. Ultimately, the hospital staff may decide on behalf of your child if you cannot agree.

Exploring all options prior to medication is best; your child’s body and brain are still developing. Therapy and different supports/treatment can be incredibly effective as well as focusing on diet and exercise. That said, based on your child’s presentation, history, and severity and type of symptoms, medication may be needed to stabilize them at least on a temporary basis. Ask questions! Then ask more. If your child is old enough, try to involve them in the dialogue. Consider your own family history; medication that has been effective with family members often works well on other family members. 

It is entirely natural to be terrified of going home after a brief or even a longer stay at a hospital.  Just because you remain concerned about your child’s safety does not mean they need to go to an in-patient hospital. The emergency department staff should work with you and your child to develop a safety plan that includes crisis numbers and text lines, identification of coping skills and strategies your child can use, and steps to take to safety-proof your home (eg: locking up medications and restricting access to sharp objects). This may include more frequent check-ins with your child, follow-up appointments with mental health professionals, and more. If your child needs more support, ask about partial hospitalization programs (PHP) or Intensive Outpatient Programs (IOP).  Link here to the Glossary page for PHP and IOP.  

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Get urgent support from a crisis service:
If this is an emergency, please call 911.

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If you or someone you know is in crisis, call the Suicide and Crisis Lifeline at 988. Here are some other resources you may find useful.

For more information on navigating a crisis, see our Navigating a Crisis page.

Medical and Health Disclaimer: togetherly does not provide medical advice. All content on this website is for educational and informational purposes only. Please contact a medical professional if you are seeking medical advice, diagnoses, or treatment.

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