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- [Narrator] When these people are getting discharged,
what do you tell them, when they're going home,
like, what are the next steps for a parent
who now takes their kid home, they're home from the hospital
and they're facing life again?
- Yeah, so I think it's important to sort
of understand why even someone would go to an ER.
And like why someone would even go to an ER
for suicidal ideation or any psychiatric thing
and I think the most important thing
is just starting from the beginning,
like the whole process.
If as a parent loved one or caregiver,
you sincerely feel that there's risk.
And what I mean by risk is risk to self, risk to others
or risk of just not doing well
because you can't take care of yourself anymore
because of a mental health issue.
So as a parent, if you're looking at your child
and you're saying, "Well, first of all,
if they said anything suicidal, that's done.
You're going to the hospital or you're calling 911
because we need to evaluate this and address it."
But there are other ways and other reasons.
I'm sorry to think about bringing your child
in for a crisis evaluation and that might be.
They're just not showering.
They're not going to school.
They're not taking care of themselves.
They're isolated.
I can't get them to do anything.
They're very flat and blunted.
We're gonna go over to the ER and get an evaluation
because that's emerging.
The other things to think about too,
are like acute psychosis.
Sometimes people have a breach of reality,
even a child can have a breach in reality
and have disorganized thinking
and if that happens time to go to the emergency department
and not just suicidal ideation,
but don't forget kids can become violent.
They can bang their head.
They can throw objects and I've seen it all.
Sometimes they're violent towards you even as a parent.
Like becoming very, very physically agitated
and that's something that needs to go to the ER as well.
So a lot of reasons why you might wanna bring your child
to the ER for a crisis evaluation
in that behavioral health setting, but once that's done
and you go through the emergency department,
there are different levels of care too.
It doesn't mean that you're gonna go to a psychiatric unit.
You might go to an outpatient facility
that has a higher level of care than like a once a week.
So I wanna everyone to be clear about that.
So it depends on the risk.
Let's not forget something inpatient psychiatric services
is for short term emergency psych care, plain and simple.
It's not a cure it's to keep someone safe,
to get them properly diagnosed,
to get them on the appropriate treatment
and then to put together a plan when they go home.
That's what inpatient psych is for.
Now, if you go to the emergency department
and let's just say,
your child has some passive suicidal ideation,
meaning they don't really have an intent or a plan,
but they do have some thoughts
and the crisis intervention team says,
"I don't think this warrants an acute inpatient
hospitalization, but maybe an IOP,
which is an intensive outpatient program
or partial hospital."
Which means you don't stay at the hospital,
but you go to a day program
that might be the level of care that they need.
So just because you bring your child
to the emergency department,
I don't want you to think that they're gonna end up
in a psych unit overnight.
They certainly may, if there's an acute safety issue,
but there are other options.
And like I said, "A partial hospital,
which could be a day program.
There could even be what we call IOPs,
which are just a few times a week."
But there's so many different levels of care.
It could be just setting them up with a therapist
and a psychiatrist that they see.
Even less of an interim,
but the point is there's different levels of care
and that's gonna sort of be determined
when you get to that crisis intervention service
at the emergency department,
but let's think about when you're being discharged
from the hospital now.
So if you go to the ER,
or even if you went to an inpatient psychiatric facility
and your child went to an inpatient psychiatric facility.
I should say, and they spend a few days there.
I want parents to be very, very informed
of the care that's going on.
So right from the time that they go to the ER.
You should be asking a lot of questions
and taking a lot of notes and what I mean by that is
what level of care do you recommend?
Inpatient, partial hospital,
intensive outpatient programs, take notes.
If they do go inpatient, who's the doctor gonna be?
Who is the clinical case manager gonna be?
What is the daily structure look like?
What are the visiting hours?
Can my child call me?
Can they have their cell phone?
Can they have their computer?
Will there be schooling available?
So asking a lot of questions and taking a lot of notes,
so you're prepared.
And then when they're on an inpatient unit, for example
or even an intensive outpatient program.
I really want to encourage parents to be very, very involved
in that process.
For example, there's always a family meeting
and it's very important what history you bring to the table
as a parent because you might know things about your child
and your family, that your child doesn't know,
that could be very, very pertinent information
for the treatment team, such as your own mental history
and family, mental history a potential history of diagnoses
like depression in the family,
for example, or previous suicide attempts
by anyone else in the family.
That's all very pertinent information.
So you're gonna bring a lot to the table as a parent
at the family meetings
and discussion with the intake coordinators and the doctors.
So I just really want you to be very,
very involved in the process.
So that being said, by the time your child is discharged,
whether it's discharged from the ER,
or it's discharged from an inpatient unit,
or it's discharged from a hospital after a few weeks
of going every day.
You should really have a good idea of the trajectory
and the plan for that discharge
and it's usually like a step down model.
So if it's inpatient, they'll usually step down
to what's called a partial hospital,
which is just a day program.
If it's a partial hospital, maybe they'll step down instead
of going every day after a week or two,
they'll go every other day.
If it's a partial or an IOP,
maybe they'll step down to seeing a therapist once a week.
So it's usually a step down program
and you should get some really good guidance
depending on the circumstances with your child
as to how to handle them day-to-day
and what to look out for at this point,
because you should be educated
from this whole experience as well, not just your child.
This is a family intervention.
And a lot of things that we do after a child has a suicide
attempt is not only looking out for these red flags
that we talked about,
but sometimes really like locking up the medicine cabinet,
if it was an overdose and reducing accessibility
to means of harming themselves.
To having supervision and oversight
and not really leaving them alone at home
for a time period, until you can regain trust and stability,
but that's kind of how the process goes.
And I know that can be very confusing
and daunting for people,
but I think if you go in knowing that
you're just gonna be so much more emotionally prepared
and just logistically prepared as well
to deal with what's happening.
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