Do we go to the hospital?

If your teen has told you they don’t want to live any more, has started to self harm, is exhibiting signs of depression or any number of things that may make you afraid and wanting help, let’s talk about it.

I want to explain something that is often misunderstood. The sole purpose of the Emergency Department is to keep people from dying.  That is it.  Contrary to general understanding, they are not there to make people better, they are only there to keep them alive.  And they are generally excellent at that.  But there is often a disconnect between what the patients believe the goal is and what the medical staff understands it to be.  This is true for all medical issues, not just mental health ones.  The ED is there to stop the bleeding, set your bones when they are broken, help you breathe again when you are having an asthma attack or pneumonia and a million other things. They are there to stop your heart attack, but they are not there to treat your heart condition.  They are there to keep you from overdosing but they are not there to treat the mental health problems that lead to the overdose.

It is really important to understand what outcome you are hoping to get from the ED.  And it is important to know what they can and can’t do, and also what they must do, and then finally, what their limitations are.

(This leads me to a side note about mandatory reporting.  These are laws and rules that are usually set at the state level and are there to protect the health and safety of children, the elderly and vulnerable adults.  Many people who work or volunteer in schools, healthcare professions, law enforcement or non-profits in the community are mandatory reporters.  Suicide falls squarely in the parameters for a lot of mandatory reporting, so familiarize yourself with the rules in your state and school.)

Most parents who just found out that their child is thinking of ending their life, are terrified and want to do anything to keep that from happening.  This is new, scary,  information and no one feels prepared to deal with it.  The first instinct is often to go to the professionals, people who know what to do.  It feels like “This is life or death and there has to be someone who is trained to solve this problem, because I know it is definitely not me!”  You want your kid to be and feel safe.  You want them to see the bright future you see.  You want to hear them laugh again like when they were little and care free.  These are the correct goals and you should pursue them.  They are, however, not the same goals that the ED has for your child.

The goal of the ED, in terms of your child, is to correct any action that has been taken to end life and to keep your child from taking action while under the care of the ED.  But the care of the ED is temporary.  If they decide that your child is not an imminent threat to themselves (or others), they will release them.  While you will feel wildly unsatisfied, their job is complete.  If there is space in the hospital’s pediatric psych ward or if they are able to find space in another facility and they believe your child is an imminent harm to themselves, they may admit them.  This may or may not be a good fit for your child and you may or may not have a lot of say in how it plays out.  And this is the psych ward, not the peds floor.  Visiting hours are very limited and access to your child and their treatment and professionals can be very limited.  There are some great facilities and I’m not trying to say anything bad about them.  I’ll make another guide that goes more in depth about in-patient care.

My point here is that as much as you probably feel totally unprepared to deal with this situation, the Emergency Department is likely not the answer you hope it to be.  I should also take a moment to say that I have the greatest respect for the incredibly committed and caring people that work in the hospital, especially the ones who work on the peds floor, in the ED, in the psych wards.  My intention is not to disparage them in any way.  They do herculean things every day and have grit and compassion that is unmatched.  My point is that there is a discrepancy between what they are there to do and what we want them to do.  We want them to put our lives back together.  We want them to show us a path forward.  We want them to make this all better.  And if that is the result that we are expecting, we will be frustrated and disappointed.  And that is not a good outcome for them or for us.

So what outcomes do you want for your kid? Before you take action, try and think it through and identify what steps will get you closest.  Maybe it is one-on-one therapy, maybe it is some kind of program?  Maybe a visit to the pediatrician or a meeting with the school counselor?  Do any of your friends or relatives have any experience with this?

I hope that no one in your family has to go to the Emergency Department for any reason, but if they do, I hope this has helped to adjust expectations so that optimal results can be achieved.