You may already be a member of the 911 Club, a community of parents who depend on emergency services for managing their mentally ill child. Our T-shirts are black and blue like bruises. Only people raising a mentally ill child or young adult join. Club rules are simple:
1. Focus on safety first.
2. Continually manage the trauma you and your family experience.
3. Accept that no one is guilty or a failure.
4. Ask others for emotional and physical help.
Every day, an emergency is just around the corner.
Parents with troubled children, no matter the age or diagnosis, are forced to make difficult decisions and take extreme actions… like calling 911. It’s not something they choose, and they’ll avoid it if possible. They are like any other parent with a severely disabled or physically ill child—they will do anything to help their child, but instead of wheelchairs or chemotherapy, they need emergency responders.
Ten things that parents of troubled children often do:
Call an ambulance
Call a crisis line repeatedly
Search a child’s room, especially if the child is a teenager or may be suicidal
Spy on their child: read their email, texts, social media or search histories, read their journals
File criminal charges or get a restraining order
Lock up common household items (matches, knives, scissors, fuel, chemicals, and anything conceivably dangerous in the wrong hands)
Participate in endless meetings, appointments, and therapy sessions. Complete dozens of forms and continually pursue financial or community mental health resources
Block out people who used to be friends, block their child from troubled friends
Never share stories with ‘normal’ people to avoid bombardment with uninformed and unsolicited opinions.
Parents can see an emergency coming, but can do little to prevent it.
All parents of troubled children have barriers to getting help, even when it’s blatantly obvious that the child needs it. Why? The aftermath of a recent high school shooting in Florida by provides details:
The tragedy has to happen first: “A neighbor warned the sheriff’s office …and begged them to intervene. She was told there was nothing deputies could do until Cruz actually did something.”
Mental health professionals don’t take history into account; and they are ignorant that children can behave well in their presence: “An investigator … spoke to Cruz, and advised that he was “not currently a threat to himself or others” and did not need to be committed.
Family and other eyewitnesses are ignored by the people and institutions they depend on. “Lynda Cruz’s cousin warned deputies Cruz had rifles and pleaded for them to “recover these weapons.”
Policymakers, mental health professionals, and emergency responders out there: fix this!
Part of the reason parents or family of the mentally ill person can’t get timely help is because of civil rights laws. To those in the mental health community, start talking about how to handle this. The present situation is unacceptable! Stop protecting an acknowledged dangerous person’s rights over those of innocent victims. It’s not OK. This is just like some gun advocates who think it’s more important to sell assault rifles to protect their personal rights over those of innocent victims.
An upsetting thing happened in my city about 10 years ago that could have been my story. A man took his grown son to the emergency room because the son had been insisting he was going to stab someone—he suffered from untreated schizophrenia. When there, the staff found no reason to hold the son despite his history of violence and his father’s testimony. The father pleaded with them to put his son in a 72-hour hold and they refused.
Within minutes, the son ran off into the surrounding neighborhood, and within an hour, had stolen a steak knife from a restaurant, and ran out and stabbed a man walking on the sidewalk. (The victim lived, fortunately.) The father told the reporter that he’d been trying every possible means to stop this from happening in the hours before the event. Getting the son to go with him to the ER was an extraordinary feat in and of itself. He was beside himself with frustration and sadness and anger. Now his son had aggravated assault and attempted homicide charges, and faced prison instead of a hospital.
U.K. needs to be a “999 Club”; Germany needs a “112” Club; a “110 Club” in China…
You can sense there will be a crisis long before it happens. You have days when you’re so concerned about your child and family (and work and responsibilities) that you can’t think straight. You can’t even spend time on little things like chatting with a friend or reading a magazine. Your intuition says it’s only a matter of time and you won’t be able to handle it.
Before this happens, make a Crisis Plan with these priorities in order:
Safety for everyone comes first
Stabilization and treatment for your child
Stress reduction for the family afterwards
What constitutes a mental health crisis?
When something dangerous has happened or is likely to happen because of a child’s behavior, words, plans, or triggering events that they experience.
Anytime a child’s behavior leads to harm or imminent harm to the child or someone else (including pets), or significant damage to property. Harm also includes emotional harm, threats, running away to unsafe places or doing unsafe things.
Trust your gut and trust your intuition.
Examples of a crisis when you must act
Watch. Pay attention to evidence your child has plans for suicide, which may include seeking dangerous items; or making multiple references to hating life; or they have a worsening mental state, or there’s been a prior suicide attempt. Try this: “Use the “S” word: talk openly with your child about suicide.”
Look for increasingly troubled behavior over time that leads to extreme behavior: non-stop raging, assault, repeated running away, threatening, talking about strange things, or spending too much time alone.
Pay attention following a traumatic event, such as someone else’s suicide or a newsworthy major tragedy. These can trigger a child to act dangerously on thoughts they already have.
The child runs away while psychotic, or depressed, or with a dangerous person–perhaps another troubled child–or under the influence of drugs or alcohol.
Psychosis of any kind including hallucinating or hearing voices; odd ideas; extreme agitation, anxiety, or paranoia; or a belief they have special powers.
The Crisis Plan
Have a crisis plan for home, school, and any other place where the child spends time. For some, it’s also the parents’ workplace. If a child is in college, a student adviser or someone in the campus health clinic needs to be a contact for checking in on your child.
Plan A: call 911. You will not be bothering the police or emergency responders!
Plan B: Answer these questions
For a runaway. Who gets on the phone to call 911, and who goes out to look for the child and bring him or her back without mutual endangerment? Both should know how to work with police and other community members. There is no waiting period in a missing person’s report. Check this article for what to say in call and do when police arrive. “How to work with police once you’ve called 911.”
Note: children have been known to behave perfectly once the police arrive, and police sometimes implicate the parents as having the problem. Don’t let this bother you. You have demonstrated to your child that you are willing to call the police, and you’ve asserted your authority. You might point this out to them–another episode of extreme behavior will be countered with significant action on your part. Use a neutral tone and avoid making this sound like a threat!
Who else knows your child and is trustworthy: others parents, businesses, teachers, their friends? Are any of them able to assist you with talking to your child or keeping them safe? Can any them help you “hold the fort” while waiting for an emergency responder? Build a support network in advance:
Who gets on the phone and calls for extra assistance? And is there a list of phone numbers? Does your town or city have a crisis response team for kids? What about a crisis line run by the mental health authority? Check. They are there to help.
Who should be appointed to communicate with the child? This should be a family member or friend or teacher that the child trusts. Communication with the right person can solve things fast, but with the wrong person can backfire, even from a parent… perhaps especially from a parent.
Who should step in and break up a fight, physical or emotional? And what specifically should they do or say to de-escalate a situation spinning out of control? Think about this: your troubled child can often tell you exactly what works best and what makes things worse. Listen to them. It doesn’t have to sound rational to you as long as it works.
How should a time-out work? Who counts to 10, or who can leave the house and go out for a walk? Where can someone run to to feel safe and be left alone for a while? What are the emotional safety rules for when the time out ends? How can you and your child trust each other enough not to upset a fragile stability?
What should teachers or co-workers or others do to calm down a situation and get their classroom or office back to normal as quickly as possible?
Can a sibling stay at someone else’s house until things cool down at home? Which house? Sibling(s) can benefit from an escape to a friend’s house to protect them emotionally until a crisis has passed. Ask them.
Think of your family and support network as a team that springs into action when someone sounds the Red Alert that your child is in danger. Talk to family members and friends or neighbors ahead of time and give them an assigned role. Let each should know they will be backed up. This will be tremendously reassuring. Your child’s crisis will be an upsetting event, but reasonable people will pull together when they know what’s going on and what they should do. “Gang up on your kids: Parent networks for tracking runaway children”
Experiences and evidence shows that a rapid reduction of stress is effective at reducing the emotional wounds of a crisis. Rapid cooling down of emotions, or “de-escalation,” is what prevents or limits the fallout from a crises. You and your family can develop de-escalation techniques for bouncing back in tough situations. The goal is “resilience.” More than anyone, families with troubled children need resilience.
After the crisis
Everyone gets a mental health break. This could be anything: a day off, eating out, ice cream, going out for a movie… Do something to get everyone back to an OK place and on their feet. There should always be a reward for bravery, team work, and a job well done.
Next time it happens
There will be a next time. A troubled child will be fine for many months and you’ll be so relieved, and then WHAM. Use a previous crisis as a learning experience. What can be done better next time?
Your long-term goal is to reduce crisis frequency over time, or prevent them from happening in the first place.
Many parents have taken these steps to prevent a crisis or limit its severity.
Communicate directly with a police officer or precinct, school counselor, or juvenile justice official to explain your child’s legitimate mental health disability and your willingness to cooperate. Build a working relationship with them.
Locks on doors: a sibling can protect him or herself and their belongings; a parent can protect belongings, prescriptions, valuables, and money.
Track via technology – Track where your child goes and what they see online, and let them know you are doing this. This is legal.
Track via eyes and ears on the street – Befriend or build trust with your child’s friends, their parents, their teachers, neighbors, and businesses where they hang out. Ask for a report if they see or hear something of concern. They may not be able to do anything but just report.
Search the child’s room for evidence of unsafe behavior, anything from razors for cutting themselves, harmful substances, porn, weapons, unusual ‘stockpiles’ of stuff (lengthy explanation goes here… just trust your gut if something is out of place). Room searches in your home are legal, but keep them secret and avoid acting on other things you find that aren’t 100% related to danger
Lock up dangerous items even though it’s inconvenient for you–kitchen knives, weapons, alcohol, drugs and prescriptions, matches, etc.
Lock up money, credit cards, and valuables. With money in hand, your child is on a path to victim-hood or association with people with criminal behavior. For example, they can buy drugs and alcohol from inappropriate people who then rob or assault them.
Confront people who undermine your authority. This is often a friend’s parents or other person who thinks you are abusing your child (because your child has told them so). They ‘rescue’ your child and offer safe harbor, and actively help them run away. This is completely against the law, and they are subject to police action and criminal charges. People who do this do not have your child’s safety in mind.
There may be times when, for reasons of safety, you may to do things you are uncomfortable with while you wait for police, ambulance, or friends to arrive. These are things parents have done in a crisis: tackle a child and hold them down; or trick a child to get in a car and then have someone hold them down until they arrive at an emergency room (commonly needed in rural areas). The way to avoid the risk of being charged by your child with abuse or assault is to have those open relationships with the authorities, teachers, and other parents who know your situation. A letter from a doctor can be really important here. I was glad I had one.
There will be fallout if you use force or trickery. Your child will not accept your reasoning or the necessity for your actions. You can truly apologize for upsetting your child but without admitting guilt. Instead, ask what they want to happen next time they are in a crisis. You should also honestly reassure them you will never use extreme methods again unless there is a safety issue.
Trust your gut
Follow a plan that includes others working as a team
Take care of everyone afterwards
Prepare for extreme measures
Retain your authority as a parent by establishing supportive relationships.
Don’t let your family become emotionally battered when your troubled child or teen goes through one crisis after another. It’s the last thing your family needs—more stress and exhaustion! Since your main job as a parent or caregiver is to reduce stress, you must manage the inevitable emergencies in a way that quickly settles down your family, as well as get help for your child. Are you prepared to head off a crisis when you see one coming? Does your family have a crisis plan for when (not if) your troubled child has a mental health emergency that puts everyone or everything in danger?
Never be afraid to call 911 when there’s a danger of harm. You will NOT be bothering them!
I got my crisis plan idea from the “red alert” scenes on Star Trek, when red lights flash and an alarm sounds, and crew members drop everything and run to their stations with clear instructions for protecting the ship.
Think of your family as crew members that pull together when someone sounds the Red Alert because your child is becoming dangerously out of control. Each family member should know ahead of time what to do and have an assigned role, and each should know they will be backed up by the rest of the family. This will be tremendously reassuring to everyone. Together, you can manage through a crisis, reduce the dangers, and ensure everyone is cared for afterwards.
Have a crisis plan for the home, the workplace, and the school…
…and start by asking questions. Here are some examples:
oWho goes out and physically searches for a runaway? This person should be able to bring the child back to school or home without mutual endangerment, and they should know how to work with police or community members.
oWho gets on the phone and calls key people for help? Who do they call, the police or a neighbor or a relative? Does your town or city have a crisis response team for kids? Some do.
oWho should be appointed to communicate with the child? This should be a family member or friend that the child trusts more than the others.
oCan a sibling leave to stay at someone else’s house until things cool down at home? Which house? An escape plan for a sibling can protect them and help them manage their own stress.
oWho should step in and break up a fight? And what specifically should they do or say each time to calm the situation? Believe it or not, your troubled child can often tell you what works best and what makes things worse. Listen to them. It doesn’t have to sound rational to you if it works to calm them down quickly.
oHow should a time-out work? Who counts to 10, or who can leave the house and go out for a walk? Where can someone run to feel safe and be left alone for a while?
oWhat should teachers or co-workers do to calm down a situation and get their classroom or office back to normal as quickly as possible?
Experiences and evidence has shown that a rapid cooling down of emotions and rapid reduction of stress hormones in the brain supports resilience—the ability to bounce back in a tough situation. Your entire family needs resilience, not just your troubled child. A simple crisis plan makes all the difference.
Q: Should I call 911? I’ve been told I should call the police or mental health hotline when there’s a crisis, but how do I know when it’s a real crisis?
A: If your child is doing something dangerous to him or herself, or others (including a pet), or property, and if you can’t manage it or stop it, call. “Dangerous” means threatening, harmful, or abusive. Emergency 911 dispatchers, police, and mental health crisis workers all encourage anyone to call, anytime. You will not bother them. I once visited a 911 facility and got a chance to ask to speak with the staff and this was their message. They described the many ways they can respond when a child or teen “blows out,” runs, or becomes suicidal.
Once you call the police:
Advice from the Federation of Families for Children’s Mental Health (www.ffcmh.org).
1. Remain as calm as you possibly can.
2. Provide only facts as quickly and clearly as possible.
EXAMPLE: I am calling from [address]. My 13-year-old son is threatening to cut his sister. He has [diagnosis] and may be off his medication and under the influence of alcohol. There are 4 of us in the house: my mother, my son and daughter, and myself.
3. Identify weapons in the vicinity or in your child’s possession and alert the dispatcher
4. Be specific about what type of police assistance you are asking for.
EXAMPLE: We want to protect ourselves and get my son to the emergency room for a psychiatric evaluation, but cannot do that by ourselves. Please send help.
5. Answer any questions the dispatcher asks. Do not take offense when you are asked to repeat information. This is done to double-check details and better assist you.
6. Offer information to the dispatcher about how an officer can help your child calm down.
7. Tell the dispatcher any addition information you can about what might cause you child’s behavior to become more dangerous—suggest actions the officer should avoid.
EXAMPLE: Please don’t tell him to stand still. He cannot hold his body still until he calms. If you can get him to walk with you, he can listen and respond better. He is terrified of being handcuffed. Please tell him what he needs to do to avoid being handcuffed.
REMEMBER: Your primary role in this situation is to be a good communicator. Your ability to remain calm and provide factual details is critical the outcome of this situation.”
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What is your local police force like? Call the non-emergency line and check, ask questions about how police typically respond to situations where a child or teenager is diagnosed with a mental disorder and out of control.
In many parents’ experiences, including mine, the police were very helpful. Others have had poor experiences. Some said their child calmed down and appeared normal once the police arrived, and they felt the police assumed they were exaggerating. Some said the police only aggravated the crisis, and in a very few cases, the encounter lead to tragedy.
In 2007, I attended the national conference of the Federation of Families in Washington DC, and learned from the President of the National Association of Chiefs of Police, Ronald C. Ruecker, that the NACP has made a commitment to promote police training in crisis response to children with mental disorders, including information about the disorders and their manifestations.