Signs of a Mental Health Crisis: When to Call a Hotline and When to Go to the ER

Signs of a teen mental health crisis and that your child needs professional support (or increased support)

• Inability to perform daily self-care, like brushing their teeth and hair, bathing or changing clothes
• Major changes to eating habits, such as not eating at all or binge-eating
• Significant changes to sleep, such as not sleeping at all or sleeping more than usual
• Drinking alcohol or using drugs
• Rapid changes to their mood, such as suddenly being depressed or withdrawn, or suddenly being happy or calm after a period of depression
• Sudden or increased energy, like pacing or being unable to sit still
• Increased agitation or aggression, including verbal threats and destruction of property
• Putting themselves in danger by running away, placing themselves in risky situations or driving dangerously and at excessive speeds
• Hurting themselves or talking about hurting themselves, including small cuts and injuries that are not life-threatening
• Isolating themselves from family, friends, school or activities
• Talking about death or dying more generally, such as saying they wish they were dead, but without any thoughts or plans to act

If you see these signs, it's time to increase support for your child. Read on for details.

Signs that your teen is in a mental health emergency and needs immediate evaluation

The signs above plus any of the following signal that your child needs immediate help:

• Having thoughts about killing themselves
• Talking about killing themselves (suicidal thoughts over the past few days)
• Any plans to kill themselves, such as timing, method or other specifics
• Severely hurting themselves, including cuts or injuries that are life-threatening
• Threats or plans to harm others
• Hearing voices, seeing things that aren’t there or experiencing other symptoms of psychosis
• Experiencing a drug or alcohol overdose
• Making a suicide attempt

With signs of a mental health emergency, seek help immediately.

More from our experts

“If your child says they feel like they want to die, that is a sign of severe depression but not necessarily of being suicidal,” Dru says. “If they say that not only do they want to die but that they also have had thoughts about killing themselves in the past few days, that is suicidal ideation and it’s an emergency that requires a trip to the hospital.”

If your child has a history of suicide attempts, watch for the signs they showed leading up to their last attempt. “If it looks the way it did before and you sense they are headed down that same path, it’s time to get immediate help,” Dru says.

“The challenge with pre-teens and teens is that many don’t tell their parents what is going on,” Dru says. “That means it’s important to pay attention to any signs of high-risk behavior or depression and determine if they are at-risk of harming themselves.”

Often, when kids in this age group are suicidal, they tell a friend or someone else other than their parents that they are having thoughts about killing themselves. Sometimes parents are notified by their school or find signs on their child’s phone and social media or in their bedroom.

It can be challenging to evaluate whether your child is in crisis on your own. That’s why calling a crisis line is always a good first step, as is keeping in touch with their pediatrician and mental health provider if you notice sudden or significant changes in your child’s mood.

Signs that your child may be experiencing a mental health crisis and needs professional support (or increased support)

• High-risk behavior, such as threatening to run away or jump in front of a car, or doing something they know is dangerous
• Major changes to eating habits, such as not eating at all or binge-eating
• Significant changes to sleep, such as not sleeping at all or sleeping too much
• Physical aggression, such as punching walls, punching or threatening others or destroying property
• Hurting themselves or talking about hurting themselves or others
• Talking about death or dying more generally, such as saying they wish they were dead, but without any thoughts or plans to act

If you see these signs, it's time to increase support for your child. Read on for details.

Signs that your child is in a mental health emergency and needs immediate evaluation

Any of the above signs, plus:

• Having thoughts about suicide over the past few days
• Talking about taking their own life
• Threats or plans to harm others
• Hearing voices or experiencing other symptoms of psychosis
• Experiencing a drug or alcohol overdose
• Making a suicide attempt

More from our experts

The most common sign of crisis in younger children is physical aggression that seems out-of-control and potentially dangerous, says Dru. “You see them engaging in repeated and often escalating activities like punching walls or high-risk behaviors like threatening to run into the street or in front of a car,” she says. “These out-of-control behaviors may also include things like hitting, throwing things at other kids, or being sent to the principal’s office frequently for aggressive behavior.”

“In some cases, kids might even make a statement to another child about wanting to hurt themselves or others,” says Dr. Wood. “When a child in this age group is in crisis, they usually engage in these behaviors not just once or in a unique setting, but frequently and in typical settings like at home and at school.”

Typically, though not always, kids 9 and older are more likely to have suicidal ideation than younger children because they understand what suicide is and what it means, Dru says. But it’s a good idea to watch for warning signs of suicide no matter your child’s age.

When your child is in immediate danger of hurting themselves or others, it's an emergency:

• Call 911 or take them to the nearest emergency room. Stay with your child while you wait for help.
• If you can’t drive to the emergency room or can’t drive safely, call 911 and ask for an ambulance.

If you just aren’t sure, start with a crisis line: They can help you determine the right next steps and get you to an emergency room if needed.

“With a child who is suicidal, it’s very important to get help immediately,” Dru says. “Do not stay at home and try to watch them, because you can’t watch someone every second."

Call or text a crisis line

During a crisis or when someone can’t calm down, professionals at Colorado Crisis Services can help you evaluate your child and provide tips for soothing them. If they deem that you need emergency attention, they can help you get it.

“If you’re not sure what to do, always feel free to call the crisis line,” Dru says. “They’ll walk you through it and help you find the resources you need.”

Talk about it with your child

We encourage parents and caregivers to check in with their child regularly. Ask them how they are feeling, listen without offering advice, and repeat back to them what you heard so they know you are listening. The goal is to provide support and find out whether they are a risk to themselves or others so you can determine what action to take. If they don’t address thoughts of wanting to die or self-harm, ask them directly. While some people worry that they might plant the suggestion of suicide by asking, that’s not the case, say Dru and Dr. Wood. By asking them, you will signal that you care and create open lines of communication.

Learn how to talk to kids about suicide.

Increase mental healthcare

If your child is not already under the care of a mental health professional, find help as soon as possible. You can also contact their pediatrician.

If your child is in therapy, talk with their therapist or psychiatrist about increasing their weekly sessions and explore more intensive treatment options such as intensive outpatient programs (IOP) or partial hospitalization (PHP) programs, sometimes referred to as day treatment.

Show them you care

Increase support at home and with loved ones. During times of crisis, it’s important to ramp up every type of support, including time with loved ones from grandparents to close friends. Dr. Wood says that even simple, passive things, like watching a TV show or movie together, can be helpful. “Activities that don’t involve talking but do increase the time your family is together can help – and they make it easier to monitor your child’s safety at the same time.”

Keep close watch on your child and prepare for next time

Save crisis lines as contacts in your cell phone. If your child has a phone, make sure the crisis line is saved in their phone so they can call (or text), too.

If a school counselor is involved, Dru recommends being in touch and requesting they check in with your child periodically.

Another thing parents and caregivers can do to monitor children who are struggling and be vigilant for signs of escalation is to install parental control apps on their phones. These can flag dangerous words or phrases used in communication and web searches (suicide, for example). One such app is Bark.

Safety proof your home

When children and teenagers are distressed or in crisis, they can become highly impulsive, and the emotions they experience can be very intense. (Being emotional and impulsive is a normal part of development and adolescence, and experiencing these things isn’t “bad” or “unusual.”)

So, even if you don’t think your child is at high risk of harming themselves, experts recommend that you look around your home and safety proof it. This includes locking up firearms, securing medications (both over-the-counter and prescription) and safely storing cleaning supplies. By removing or restricting access to potentially dangerous items, you lower the risk of self-harm or suicide and help keep your child safe.

You can call the crisis line for many different reasons, or even just to talk.

Reasons people call include:

• Help evaluating a mental health crisis
• Anxiety
• Bullying
• Concerns for family or friends
• COVID-19 pandemic related stress
• Depression
• Financial concerns
• Loneliness
• And much more

No problem is too small, and you will not take away from others’ needs. The experts who take your call or text can help you find appropriate care or talk to you about what you are going through.

For children under 10, Dru recommends going to a children’s hospital if possible. Most hospitals, whether they specialize in children or not, are prepared to see adolescents in crisis. What’s most important is getting help right away.

When you arrive, your child will be medically evaluated to see if they have harmed themselves and they will receive a mental health evaluation to assess risk to themselves or others, says Dr. Wood. “In any kind of crisis, the assessment is focused on how risky the thoughts or behaviors are and how they can be safely managed.” The evaluation will include questions about the child’s access to dangerous items and a plan for restricting their access to them.

Once your child has been evaluated, the care team — usually a therapist and a psychiatrist — will determine short-term and longer-term treatment plans. Treatment can include the highest level of care, which is inpatient psychiatric hospitalization and is similar to the intensive care unit but for mental health. The goal is to stabilize the child so they can be safe when they return home. Other levels of treatment include intensive outpatient treatment, partial hospitalization and urgent or frequent individual and family outpatient care. Intensive outpatient treatment and partial hospitalization means that patients are in treatment during the day and come home at night. All levels can include therapy and medication.

“If your child is hospitalized, how long they stay depends on how well they meet the goals that they set with their treatment team,” says Dr. Wood. “Length of stay also depends on the level of supervision and monitoring they need for their safety. A typical length of stay is around five to seven days.”

If your child is admitted to the hospital, your ability to visit will depend on the rules of each facility and current health protocols. (Many facilities allow video visits if in-person visits are restricted.)

If your child does not require hospitalization, after their assessment, they will leave the hospital with a safety plan, a treatment plan and a restricted access plan that guides you in removing or locking up dangerous items such as firearms, ammunition, knives and medication.