In this discussion post, I will discuss an adult psychiatric emergency. After describing this emergency, I will describe how I would handle this differently if the patient were a child or adolescent. Lethal and ethical issues will also be discussed when dealing with children.
In my experience, I have assessed adults who were suicidal, had a plan, and under the influence. Having worked many years in the correctional system, inmates would often arrive under the influence of one or multiple substances and would state they were suicidal and at times have a plan to carry it out. We treated this as an emergency and placed them immediately in on suicide watch with Kevlar suit as well as assessed for any withdrawal inmate may go through based on the report use and urine drug screen.
If a child or adolescent reports that they are suicidal, it would be emergent to further assess this patient. If child is less than 12, they are at a significantly lower risk for completing suicide likely based on cognitive maturity (Sadock, Sadock, and Ruiz, 2014). I would interview available family members independently to determine any further risk factors such as family discord, access to firearms, previous suicide attempts and/or ideations, and any other psychiatric history. Parents with a psychiatric history or suicide attempts to increase the risk for their child making it very important to obtain to complete a psychiatric assessment (Kendler, et al., 2020). If able, I would also reach out to teachers and the school social workers. Gathering data from all resources will all me to further understand the case presenting as well as determine risks for a child presenting. Safety would ultimately be assessed to determine if hospitalization is required. Substance use for the child/adolescent would also need to be assessed to determine if patient is coherent to assess. If the child is found to have substances on board, I would need to wait until they are cleared to accurately assess the child.
Treating children and adolescents who are suicidal bring about much complexity as you are dealing with patient and their caregivers. If the family is found to have much turmoil, they may not be able to safely care for the patient. According to Dardas (2019), how the family functions will impact the outcome of the suicidal child. If the family function is found to be abusive, dysfunctional and/or having turmoil, legal action will often need to happen.
When treating children and adolescents who are suicidal, it is my job as a provider to protect them. If during the assessment there is found to be any type of abuse or neglect, I must report the case to local authorities. With suicide being the second leading cause of death for adolescents, I must incorporate all the resources to provide safety for the child (Asarnow and Mehlum, 2019). Ethically, I must be aware of all the factors that may be causing the child to be suicidal.
Overall, treating children and adolescents requires more than treating the patient. The family/caregivers also need to be assessed to determine if there are other areas troubling the patient to increase their risk of suicide. It is also important to request information from schoolteachers and social workers if applicable. Providing safety is the ultimate priority and then moving forward with a treatment plan based on information obtained.
Asarnow, J. R., & Mehlum, L. (2019). Practitioner Review: Treatment for suicidal and self-harming adolescents – advances in suicide prevention care. Journal of Child Psychology and Psychiatry, 10, 1046. https://doi-org.ezp.waldenulibrary.org/10.1111/jcpp.13130
Dardas, L. A. (2019). Family functioning moderates the impact of depression treatment on adolescents’ suicidal ideations. Child & Adolescent Mental Health, 24(3), 251–258. https://doi-org.ezp.waldenulibrary.org/10.1111/camh.12323
Kenneth S. Kendler, M. D., Henrik Ohlsson, P. D., Jan Sundquist, M. D., Kristina Sundquist, M. D., & Alexis C. Edwards, P. D. (2020). The Sources of Parent-Child Transmission of Risk for Suicide Attempt and Deaths by Suicide in Swedish National Samples. American Journal of Psychiatry, 177(10), 928–935. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ajp.2020.20010017
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.