Crisis Intervention

It was more than two decades ago that Dr. Wharff began to look more closely at boarding within her hospital. She wondered why crisis intervention—or immediate, urgent treatment—was not a part of emergency psychiatric treatment, the way it is for non-psychiatric medical emergencies, where the standard is assess, treat, and discharge. Dr. Wharff asked herself: “’How can we imitate medical emergencies, by developing an intervention that we could do in the ED, without the need to admit the patient to the hospital?’”

What seemed to dramatically help suicidal adolescents and their families most, as Dr.  Wharff noticed, was crisis intervention, including educating both children and their primary caregivers about depression, suicidality, psychopharmacology, outpatient services, and therapy. Patients would become markedly less suicidal; Dr. Wharff and her team would be able to send them home.

“I started to develop a modular intervention, designed to be carried out in the ED, during a single session, with the help of trained facilitators, with the goal of equipping kids and their families to return to the world safely,” Dr. Wharff said.

Increased Understanding

What is also crucial, according to Dr. Wharff, is working to help parents understand their child’s side of the story, and vice versa. In Dr. Wharff’s experience, suicidal patients often have a narrative about what brought them to the hospital that is dramatically different from the narrative of their family members—call it the Rashomon effect.

 “The kid will say, ‘I wanted to kill myself because my boyfriend dumped me,’” Dr. Wharff explained. “And the parents will say, ‘We didn’t even know you had a boyfriend.’ And the kid will say, ‘I never told you he was my boyfriend because you hate him.’”

Addressing gaps in understanding like that is important, so that both sides can develop a clearer picture of what is happening.

Patients also benefit from learning coping skills derived from cognitive-behavioral therapy—like how to recognize negative thoughts, and distract themselves from them. If a teen is obsessing about getting dumped, or a bad encounter on social media, going out with friends might help; so could taking the dog for a walk, or seeing a movie.

“So if a teen says, ‘I don’t want to live anymore because my boyfriend dumped me,’ you find out what things might help her think about something else,” Dr. Wharff said. “Maybe it’s listening to music, or watching a movie, or being with friends. Or, her parents can tell her, ‘You’re only 15, of course you’ll have another boyfriend.’ That can help her to re-frame her thoughts. The parent can become a coach, helping the teen to reduce her suicidality.”