The needs of young people can feel insurmountable. Whether it’s a mental health crisis, the covid-19 pandemic, or the complexities of adolescence, these challenges can lead to feelings of despair and hopelessness.
States are exploring strategies to improve access to comprehensive community-based mental health services, including crisis receiving and stabilization facilities. These settings can be more comprehensive than 23-hour observation units but less restrictive than hospitalization.
Identifying a Crisis
Youth have played a central role in many conflicts, including as protagonists of social movements and agents of change. However, their vulnerability and lack of opportunities make them susceptible to exploitation by violent groups. This combination makes them a highly polarising group that can trigger or aggravate conflict, and contribute to instability.
Adolescents may experience mental health crises for a variety of reasons. Professional behavioral health services such as therapy or counseling can help them work through their feelings and develop positive coping skills.
In addition, children and teens face many challenges in the US, including ongoing attacks on marginalized communities, racial injustices, bullying, school segregation, and a lack of economic security. These factors can trigger or exacerbate mental health crises, such as depression or suicide. Addressing these issues requires long-term changes at the institutional level, as well as interventions such as telephone hotline programs that provide therapists to help young patients. Providing such support also helps families access the resources they need to help their kids cope with crisis.
Getting Help
Many teenagers face a variety of issues, including adolescent grief; the loss of parental support; bullying, harassment, or assault at school; and the exploration of their own sexuality. This combination of factors leads to feelings of sadness or hopelessness, and often to dangerous behaviors such as drug or alcohol use, self-harm through cutting, burning, or hitting, or running away.
Even in normal times, teens are often underdiagnosed and undertreated. They also face economic vulnerabilities, such as unemployment or underemployment, and may lack access to quality mental health services.
Fortunately, psychologists are working to address these issues at the family, school, and state level. For example, they’re advocating for family-centered mental health services to prevent unnecessary entry into the child welfare system and increase reunification rates; promoting peer support services; providing counseling before, during, and after new placements or emancipation from foster care; and expanding opportunities for in-home crisis stabilization services for children and youth. These efforts are critical for helping youth get the help they need.
Getting Back on Track
Children and youth live with their families, so any child or youth crisis response must also include family members. Crisis services focus on addressing individuals in the least restrictive and most dignified setting possible, while providing treatment in line with recovery oriented principles.
Youth frequently emerge as important social actors in crises, denouncing injustices and promoting change. However, they are also vulnerable to being manipulated and exploited. They can become disruptive and prone to violence in the context of protracted conflict. They can also be drawn into armed groups, whether through forced enrolment or by joining “voluntarily”, which fuels and prolongs the crises.
The Alliance works with youth through a holistic model, acknowledging that their individual needs are tied to larger systems of oppression. This includes focusing on gender-affirming care, engaging in family work to expand opportunities for support and teaching young people how to resist. It also means focusing on prevention and education, with a particular emphasis on early intervention to prevent youth from reaching a mental health crisis point in the first place.
Continuing Care
States may want to consider expanding efforts to connect youth to a comprehensive system of home- and community-based services after they leave crisis receiving and stabilization facilities. For example, a New York model combines mobile response with intensive in-home stabilization and family support services.
Adolescents who remain connected to continuing care are more likely to maintain treatment gains and relapse prevention strategies and reduce substance use. Several studies have examined the effectiveness of various interventions to increase connection rates. One experimental condition, assertive continuing care (ACC), was associated with higher reconnection rates than more traditional referrals to outpatient treatment or mutual support groups.
Another approach is short-term residential respite programs that keep young people with complex and severe needs safe, while also supporting their recovery goals through 24/7 supervision and connections to natural supports. These programs provide opportunities for skills development, relapse prevention support and education, and connection to other services and community resources. Some randomized studies have also demonstrated promising results for this approach.