Teens in Crisis: Providing Acute Stabilization Care for Clients
In an ideal world, the decision to seek help for substance abuse or a mental health disorder is a conscious one. When clients enter treatment of their own volition, the process is typically much smoother and more beneficial than involuntary admission. Clients who are in treatment by legal order or coercion from loved ones may be more resistant to the process. The additional challenge of breaking down those guards can make getting to the root of the problem that much more difficult, especially with adolescent clients.
Safe Landing Recovery specializes in helping teens and their families heal through addiction recovery. However, because of the nature of our client base, we often receive cases where the adolescent is being placed in treatment against their will by a parent or legal authority. These situations may involve high levels of emotional distress or some level of risk to the safety of the client or others. Navigating these cases is an intricate balance between compassion and a willingness to make tough decisions based on a professional assessment.
During a recent clinician roundtable hosted by Safe Landing Recovery, our expert panel discussed the challenges of risk assessment and providing acute stabilization care for clients in crisis.
Critical Assessments: Determining the Best Course of Action
For any clinician working in the behavioral health sector, conducting a thorough assessment of the client and their needs is a vital part of the admission process. At Safe Landing Recovery, this includes both a medical and mental health screening to identify areas of concern and places where the client may need additional support. Clients are continuously assessed throughout the treatment process to monitor their progress and ensure all needs are being met to support long-term recovery.
There are instances, however, where it may become necessary to seek additional assistance from outside of our treatment program. If a client requires medical assistance for withdrawal symptoms, for instance, they may be referred to a local hospital for proper care. Likewise, if a client is exhibiting extreme distress, experiencing active hallucinations, or engaged in dangerous behaviors which cannot be reasonably managed by our staff, an involuntary hospitalization may become necessary.
Involuntary Admittance and the Baker Act
The Florida Mental Health Act, also known as the Baker Act, gives judges, law enforcement officials, physicians, and mental health professionals the ability to commit individuals to emergency observation for up to 72 hours in a hospital or mental health care facility. The act is intended to allow for legal measures to address a person in crisis with an intended goal of providing acute stabilization care. For the Baker Act to be initiated, the individual in question must pose a significant danger to themselves, others, or property.
In theory, the Baker Act is a fantastic tool for helping save lives and provide critical care for those in need. Unfortunately, it is a tool that has been misused and abused, creating a detrimental stigma and engendering mistrust of behavioral healthcare providers.
One primary cause of misuse is a lack of training among people in positions of authority over children and adolescents. Teachers, school officials, law enforcement, and other authority figures lack the tools necessary to de-escalate situations and may rely on extreme measures to regain control without realizing how traumatic the experience can be. In many instances, a child or teen may be acting out because they also don’t have the ability to process stress, grief, anger, or trauma.
As Safe Landing Recovery’s Tiffany Krause states,
“Every behavior is a cry for something. It’s trying to satisfy some sort of need, whether that be attention or a need for safety in an unsafe situation. Getting to the core of the matter is vital. They’re not doing it just for fun. It’s coming from somewhere; let’s figure that out. Getting to the root of it is important. Sometimes there’s not time to do that, which is where the stabilization component comes in.”
Police involvement in involuntary admission to a crisis center adds an additional layer of trauma.
“Exhaust all your options before you call the police and get them sent somewhere against their will.”
Another of our expert panelists made a point to emphasize the importance of getting to the root of a child’s behavioral issues rather than just assuming malicious intent.
“The Baker Act was used quite often for children of color — it was misused to a degree that it was becoming an issue. Teachers may not have the proper training to defuse a child in distress. There may be trauma in the home, parents thinking about a divorce, financial issues — trauma is trauma. You have teachers who are not properly trained, especially in the inner cities. Kids are being overmedicated and Baker Acted left and right. It creates a stigma that follows them grade to grade and school to school.”
It is important that educators understand the serious nature of having a student Baker Acted. After involuntary admittance occurs, it is difficult to have a child released into parental care. When a child is Baker Acted by a teacher or other authority, the parent is often left uninformed until the child is already in custody. During the length of their hold, there’s little to no communication between the child and their family, which creates even more distress and only serves to compound trauma. Involuntary admittance to a mental health facility should always be the final option once all others have been exhausted.
“It’s kind of a crutch sometimes. There are of course situations where it’s needed — if someone is definitely going to harm themselves and all the protocols and procedures to safeguard against that aren’t working, it serves a purpose. But when people are using it as a crutch to deal with defiance or talking back, that’s the concern.
There’s abuse within the system, abuse around the system, and we have to get to a place where we can have thoughtful, compassionate connections with people. That way they feel like their needs are being heard, their value is being respected, there’s humanness, and we’re really working on their needs.”
De-escalation and Alternatives to Involuntary Admission
Providing acute stabilization care for clients is first and foremost an exercise in de-escalation. When someone, especially a teen, is in crisis, they need to feel seen and heard. Creating a space where they are an active participant in de-escalating the situation helps to solidify their commitment to safety. Working together with the client to create a safety plan and identify actionable next steps in their care provides a sense of control and security that can be vital in these instances.
Stabilization and de-escalation for children and teens in distress is a communal effort. Teamwork and collaboration between mental health specialists, counselors, school administrators, teachers, parents, and law enforcement can prevent avoidable tragedies.
“Everyone has their go-to person that’s going to be able to calm them down and talk them through the crisis. That’s the person they need. WIth the team approach from the treatment program or family or schools — whatever might be going on — everyone working together is just going to make the situation that much more manageable.”
For all parties involved, it is important to learn to differentiate between serious threats of harm and words simply spoken in desperation. While all notions of suicidality or threats of violence need to be taken seriously, they are not all one and the same. Suicidal thoughts, for example, may be passive or active. When they are of a passive nature, someone is expressing difficult emotions or trauma that have impacted their will to live but may not be actively intending to end their lives. Suicidality is considered active when the person in question has a clear plan and/or has begun taking steps to follow through. For someone experiencing suicidal ideation, counseling and therapeutic support may be enough to curtail these feelings. However, someone who is actively suicidal may require hospitalization to ensure their own safety.
“There is that fine line. You can’t know someone’s intention, so airing on the side of caution is important. If someone says ‘I’m going to kill myself’ who are we to say ‘no you’re not’? The worst case scenario in that situation is a horrid thing, so it’s a real concern.”
The same is true for those expressing violent thoughts or desires. Intervention in such a case can help to de-escalate the situation and find solutions that protect the safety of all involved.
In such serious situations, how is one to differentiate between serious threats and desperation? This is where a licensed professional should be brought in. They are qualified to evaluate the individual and determine if there is an active risk present and what next steps are necessary.
They can also help with facilitating safety planning and establishing continued care. For teens struggling with substance abuse and co-occurring mental health disorders this may include a referral to a behavioral health facility like Safe Landing Recovery. Unlike involuntary admission to care, this approach gives the client and their family some sense of control and the ability to be actively involved in the treatment and recovery process. The 72 hour limit of the Baker Act is not in play, allowing for more personalized care over a longer period. Getting adolescent clients and their families to a place of willful participation greatly increases the effectiveness of care and reduces the risk of future issues.
If you are concerned a teen in your life may be struggling with substance use, Safe Landing Recovery is here to help. Contact us now for more information about our services and commitment to success for our clients and their families.