John Peterson, MD Director, child and adolescent psychiatry, Denver Health Medical Center, Associate professor, Department of psychiatry, University of Colorado School of Medicine, Denver, CO Stacey Freedenthal, PhD Associate professor, Graduate School of Social Work, University of Denver, Denver, CO Adam Coles, MD Resident Department of psychiatry, University of Colorado School of Medicine, Denver, CO
Strengthen coping skills, develop a safety plan, and treat comorbid disorders
Acknowledgements
The authors wish to thank students Scott Schubert from Regis University, Denver, CO, and Emily Peterson from Beloit College, Beloit, WI, for their help in preparing the manuscript.
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Table
Hospitalization or home? Acute crisis planning for self-harming youth
Hospitalization is more appropriate when ≥1 of the following is present with suicidal or self-injurious thoughts:
Current suicidal thoughts or plans
Previous serious suicide attempts
A need for a more lengthy evaluation in a safe setting
Significant psychiatric symptoms (especially a mood disorder and/or psychosis)
Significant impulsive and unpredictable behaviors
Continued substance abuse problems or intoxication
Conflicts with parents, family members, or a significant other
Inability to form a therapeutic alliance with the clinician
Inability to honestly participate in a safety evaluation
Home is more appropriate when:
The youth has no active suicidal thoughts or plans, history of suicide attempts, medical problems requiring hospital care, significant substance abuse problems, or psychiatric disorders (especially a mood disorder) needing acute stabilization
Precipitating conflicts or situations have been adequately diminished or resolved
A supportive adult in the home will monitor the youth’s safety and the relationship is positive and stable enough to allow a safe return
The adolescent has a strategy for communicating unsafe or overwhelmed feelings to the parent, guardian, or supportive adult, such as the use of “check-in” times and a rating scale for upset or unsafe feelings
The youth will begin or continue outpatient psychotherapy
Family has been cautioned about how alcohol and drugs can cause disinhibition and increase impulsivity, and will prevent access to substances
Parent or guardian agrees to remove or secure lethal means of suicide such as firearms
The youth and parent or guardian agree on a safety plan and follow-up services and an appointment is scheduled
The youth and parent or guardian have an identified contact person or a safe place to go, such as a hospital emergency department, if a situation deteriorates and becomes unsafe
