Getting help: Where should you start?
If you have reviewed the list of warning signs above and they seem to confirm that you child may be experiencing mental health problems, what’s the next step? Where can you go to check if he is OK and get help if he needs it?
First, if your child is in imminent danger of hurting themselves or others, take your child to the closest emergency room or call a local psychiatric hospital. Any local psychiatric hospital that takes children will generally offer round-the-clock assessments at its admissions department. A clinician will evaluate the safety of the child, get to know the child and the family, and decide if the child needs to be kept at the hospital for his or her safety.
In general, what are the options to get help for your child? Your pediatrician may help guide you for the next step of treatment. A school counselor may have insight about options available at school or nearby. But don’t stop there if you don’t feel like you are getting solid answers.
Treatment generally requires more than one component, therapy and often medication, as well as family/friend support, and personal involvement by the child.
Here are the various levels of mental health care that are available to you. We start with the most critical and urgent level of care first. Outpatient means occasional appointments like a medical doctor’s appointment. Other levels of care are hospitalization programs
1. Inpatient/acute care
Inpatient hospital care is also called acute care and is required when a child is at risk of harm to self or others. The goal of the treatment is to bring the child back to an appropriate level of safety and self-control. The treatment is typically a three- to seven-day stay, depending on the individual diagnosis and the progress of the child. Acute care treatment involves immediate evaluation, 24-hour nursing and physician attention, medication if needed and daily monitoring of medication, and a plan for future treatment. Depending on the hospital, the treatment may also include individual, group, and family counseling. Some programs offer school or tutoring.
Family visits are encouraged. The child does have a busy program of counseling, education and activities so family cannot stay an extended length of time. An acute inpatient stay is usually three to seven days long and the goal of the treatment is the reduction of the acute symptoms also called stabilization. Your child will not leave the acute hospital cured from his illness. Diagnosis and medicine adjustments take time and may not be finalized in the acute setting.
2. Longer-term inpatient therapy
When a child or adolescent between the ages of six to 17 years of age has trouble functioning well outside of a structured and monitored environment, inpatient treatment or a residential treatment center (RTC) may be the answer. Such treatment can involve 24-hour care, a full schedule of individual and/or family or group therapies, and therapeutic activities in a secure, hospital-based setting.
3. Day treatment
If counseling or psychiatric intervention can’t provide the help needed, a viable option could be a day treatment, hospital-based program, also called Partial Hospitalization Program or Day Treatment. This is designed for the child who is in between levels of care; needing more intensive therapy than an outpatient counselor can provide, but not a risk of harm to self or others. Day Treatment often involves individual, family and group therapy, typically over two to four weeks or more depending on the situation. The child attends the program during the day, and goes home with the parents each night, just like a school day. Depending on the hospital, the treatment may also include individual, group, and family counseling. Some programs offer school or tutoring.
4. Intensive outpatient
Intensive Outpatient treatment allows patients to continue their daily life while receiving group and individual services of 10–12 hours a week. It is a good option for youth who are not at risk of harm but need more support than only one or two therapy sessions a week.
5. Outpatient counseling
Outpatient counseling is provided by psychologists, licensed therapists, or licensed social workers. These professionals can help in different ways: understand the signs and the seriousness of the child’s problem, identify the possible cause or the important questions to explore further, propose a treatment approach, and conduct the treatment. These individuals are not able to prescribe medications. However, if medication is needed, they work in tandem with a psychiatrist who is specially trained in prescribing medication.
When selecting a therapist, the most important factor is yours and your child’s ability to build a rapport of confidence and trust with the professional you choose. You may ask them about how they assess the child, their treatment approach and how they measure progress.
Understand there are different levels of training among professionals. For instance, a psychologist is someone who earned a master’s degree (M.S.) or a doctorate in psychology. Those with a doctoral degree (Ph.D., Psy.D. or Ed.D.) in clinical, educational, counseling, developmental psychology or research received more extensive supervised training. Social workers also may provide psychotherapy, and they have a bachelor’s degree (B.A., B.S.W., or B.S.) or a master’s degree (M.S. or M.S.W.).
6. Outpatient psychiatric care
The counselor may feel something more serious is going on, such as a mood or thought disorder. She would then refer the child to an outpatient psychiatrist, a doctor who can assess the child further and decide if it is necessary to prescribe medications so the child can function. Note that you can also call a psychiatrist directly or a pediatrician can refer you.
Medication treatment should always be accompanied with therapy so the child can build resiliency and learn to cope with the symptoms and environment on their own.
A psychiatrist is a physician, a medical doctor, whose education includes a medical degree (M.D. or D.O.) and at least four additional years of study and training. Psychiatrists are licensed by the state. Their role is to provide medical/psychiatric evaluation and treatment for emotional and behavioral problems and psychiatric disorders. As physicians, psychiatrists can prescribe and monitor medications.
The monitoring part is essential: taking medications should always be supervised by a medical professional who is responsible to make sure the child is safe. It is also likely that the type and strength of medication will be adjusted over time to fit the child’s unique profile and needs. Do not be discouraged if medications are not a perfect fit in the first round. Because of the short supply of psychiatrists, getting this support will require efforts of research and persistence on your part.