Dr. Kathryn Jones, child and adolescent psychiatrist, answers some common questions about  mental health care for kids and what’s available at Virginia Treatment Center for Children.

One in five children will experience a serious mental illness. But how do you know if your child is experiencing a mental health crisis and where do you go for help? Dr. Jones explains.

What does a mental health crisis look like?

A mental health crisis is generally any situation where there is concern for safety or well-being based on how someone is thinking, feeling and acting.

This can include your child:

• Becoming physically aggressive or destructive
• Acting out of character in a way that feels dangerous or unsafe
• Being unable to maintain their activities of daily living or care for themselves because of their thoughts or feelings
• Wishing they were dead
• Wanting to kill themselves
• Attempting to kill themselves
• Wishing to harm or kill others

What kind of help will my child get if I take them to the ER?

In the emergency room, your child will be evaluated by the nurses and physicians for any medical reasons that might explain the changes in their behavior. They will also be evaluated by someone from psychiatry, who will assess them for safety risk and any symptoms (thoughts, feelings or behaviors) that might indicate a mental health diagnosis.

Depending on the results of these evaluations, your child may be recommended to be discharged home, admitted to a medical service in the hospital (if there is a physical health issue) or admitted for inpatient psychiatry care. At CHoR, inpatient psychiatry care is provided at Virginia Treatment Center for Children on our Northside Campus.

If it’s determined to be safe for your child to return home, case managers in the emergency room will provide you with referrals for outpatient follow-up, including the community mental health center in your area, contact information for crisis intervention services, and specific services such as medication management or individual psychotherapy if appropriate.

What other options are there aside from the ER?

There are several options you may consider instead of going to the emergency room, although if your child is a risk to themselves or others or there is imminent risk of harm, the emergency room is the most appropriate place to start (and may require 911 ambulance services for transportation if they are not safe in the family vehicle).

1. Contact your child’s pediatrician for an urgent sick visit. Primary care physicians are trained to address most straightforward mental health crises, and some are comfortable with starting antidepressant or anti-anxiety medications.
2. Contact your local community services board where community mental health services are located and request a crisis evaluation. This may involve your child being seen at the clinic itself, or crisis services coming to your home to see your child in their typical surroundings.
3. If you can access VTCC during regular business hours, call our outpatient consult clinic and request a consult appointment with our nurse practitioners and physician assistants, who will do a thorough evaluation and make recommendations for next steps.
4. Call your child’s psychiatrist or therapist to get recommendations, which can range from watchful waiting to coming in for an urgent visit to referral to the nearest emergency room to evaluate for the need for psychiatric hospitalization.

When would my child need inpatient psychiatric care?

Your child will require an inpatient level of psychiatric care if they are acutely suicidal and you do not think they can maintain their safety at home, especially if they:

• Have a specific plan to kill themselves, access to means and intent to act
• Are acutely homicidal, meaning that they want to kill a specific person or have attempted to do so (and have a plan and means to act)
•  Are unable to care for themselves and this represents a significant change in their typical behavior
• Are incapacitated, meaning they cannot make decisions for themselves because they are too depressed, anxious or intoxicated, or their thoughts are too disorganized or nonsensical
• Are too violent or aggressive or unwilling to talk with clinicians  

What does inpatient psychiatric care look like?

Inpatient psychiatric care is distinctly different from hospitalization for physical illness or surgery. Patients are assigned bedrooms, have access to single use or shared bathrooms, and have open access to communal spaces where they can eat, socialize and engage in group therapy interventions.

At VTCC, each patient has their own single bedroom with attached full bathroom and a daybed where a parent or guardian can spend the night if they choose.

Each pod of rooms is assigned several nurses and mental health partners, and every patient is assigned an individual psychotherapist and clinical team who meets with them daily. The days are structured around meals, therapy groups and school during the week, with more unstructured time on weekends and holidays.

What about schoolwork when kids are in the hospital for mental health care?

On most if not all inpatient psychiatric units, patients are able to keep up with their schoolwork if provided by parents as paper packets. Computer and internet access is generally restricted for safety reasons. At VTCC, we have a Richmond Public School on site, so with parental approval patients will attend classes and have access to teachers who can help them with their specific needs. This allows them to keep pace with their schooling and not accrue absences while they’re hospitalized.

How long could they expect to stay?

The typical length of stay for inpatient psychiatry is five to seven days (including weekends). Hospitalizations can be shorter or longer, depending on how your child’s symptoms respond to treatment and what external services need to be put into place before they can return home safely.

Determining an appropriate discharge date is a collaborative process between family, clinicians and the child.

When should I schedule an outpatient appointment and in what situations are those appointments most helpful?

If you’re concerned about your child’s thoughts, feelings or behaviors but not their safety or your safety with them, outpatient care may be most appropriate. The goal would be to get a clearer picture of whether they have a mental health diagnosis and, if so, how best to treat it.

The initial appointment will be a clinical evaluation where you and your child will be asked a few questions to get a sense of:

• What is happening right now
• What symptoms have been present in the past
• Whether there is any history of mental health disorders in the family
• How you and your child would like to proceed

This is different from psychological testing, which is a specific kind of evaluation that takes several days to complete and involves questionnaires and structured interviews. For nearly all mental health diagnoses, a clinical evaluation is sufficient and psychological testing, while helpful, may not be necessary.

What should I do if there are concerning behaviors before my child’s outpatient appointment?

If there are concerning behaviors prior to the appointment, you can reach out to the clinic to see if there are any earlier appointments or urgent visits available. You can also reach out to your child’s pediatrician or your local community services board to see if you can get an evaluation more quickly.

What is a key piece of advice you have for parents?

Whenever you are in doubt about what to do if your child or teen is acting in a way that is worrisome, scary or unsafe, we strongly recommend calling 911 or taking your child to the emergency room for an evaluation. We encourage families to err on the side of caution and seek help if they have concerns.

Find out more about the care offered at Virginia Treatment Center for Children.