When to Escalate a Mental Health Concern: A Protocol for Social Workers and First Responders
Mental health is as important to a child’s well-being as their physical health. Yet, although the American Academy of Pediatrics and other mental health organizations declared a mental health emergency in youths in 2022, U.S. teens are still struggling to cope.1
First responders and social workers can act as a bedrock for a teenager’s recovery from mental health conditions. When their support is required, this is a good indicator that a mental health concern needs to be escalated. The good news is that these professionals are in a good position to do so. They can make recommendations and referrals to much-needed mental health treatment, including the voice of parents and families in every measure they take.
If you’re a social worker, first responder, or parent who is worried about a teen’s mental health, you may be wondering if it’s time to escalate this concern. Mental health professionals can guide you through the appropriate steps in this process to safeguard a child. This article can also help by discussing:
- When to escalate a child’s mental health concern
- First responders’ role in escalating mental health care
- Mental health escalation protocol for social workers
- Intervening in a child’s mental health crisis
- When to seek help in handling mental health crises in children and teens
When to Escalate a Child’s Mental Health Concern
It’s normal for a child or teenager to show occasional emotional or behavioral issues. However, if these issues persist for longer than a few weeks or become their go-to way of managing stress, it may be time to escalate a mental health concern.
The National Institute of Mental Health highlights issues in older children that might require mental health attention. These include:
- A loss of interest in things they used to enjoy
- Fatigue or low-energy
- Changes to weight and appetite, including weight loss or gain
- Having periods of high energy and little sleep
- Spending increasing amounts of time alone or avoiding activities that involve family or friends
- Frequently complaining of physical pains that have no clear medical cause
- Engaging in risky behaviors, such as self-harm
- Having suicidal thoughts or making plans to end their own life
- Saying that they can hear things that other people can’t or claiming that others are trying to control their mind – signs of psychosis
Research shows that in recent years 6.5% of U.S. teens made a suicide plan and 3.7% actually made attempts on their life. First responders are often the first port of call in mental health crises such as these. Further, they are often involved in escalating mental health concerns to ensure children and families receive necessary support – often by contacting social workers.
Due to this level of involvement, both social workers and first responders are familiar with identifying the signs of serious mental health conditions and making recommendations for mental health treatment.2
First Responders’ Role in Escalating Mental Health Care
First responders tend to be the first people to arrive on the scene of an emergency – including those involving mental health. First responders include professionals such as:
- Law enforcement officers
- Firefighters
- Paramedics
- 911 dispatchers
- Emergency medical technicians
Many first responders are often trained in mental health. Therefore, if a call is made to emergency services about a mental health crisis or concern, these professionals are usually dispatched to provide support and assistance. In fact, up to one-third of people with serious mental health conditions first encounter mental health treatment through interactions with first responders.3,4
Mental health first responders can help a child or teen experiencing a mental health crisis by listening to them non-judgmentally and assessing the situation and risks. If they determine that a teen has mental health needs, they can guide them toward suitable mental health services.
To put it another way, the role of a first responder in escalating mental health care can be described by using the acronym FIRST:5
- Find out if there’s a mental health problem
- Investigate the problem by asking questions, including about the risk of suicide
- Reassure the child and their family
- Signpost towards mental health services or offer support
- Take care – helping them practice self-care and arranging referrals
The role of a first responder doesn’t end after their initial encounter with a child. They will make recommendations on where to find support – as well as continue to check in on the child and their family. This continued assistance can help the child understand that they’re not alone in what they’re going through.
Requiring the support of a first responder in safeguarding a child’s well-being in a mental health crisis means that further steps will likely need to be taken to protect their well-being. Often, this means contacting social workers to ensure the mental health concern is escalated.
Mental Health Escalation Protocol for Social Workers
Research shows that requiring the involvement of first responders and social workers to protect mental well-being is a strong indicator that a child may have a serious mental health condition. For this reason, social workers may need to escalate a mental health concern to ensure that a teen receives the appropriate outpatient or residential treatment for their needs.6
A social worker’s escalation protocol may vary depending on a teenager’s symptoms and circumstances. However, if a child is experiencing a mental health crisis, social workers may take the steps detailed below to safeguard their well-being.
Social Worker Procedures for Escalating Care
A social worker may keep to the following procedure for escalating a minor’s mental health concern.7-9
Conducting a Mental Health Crisis Assessment
If a child is experiencing a mental health crisis, a social worker will conduct a risk assessment to determine whether there is an immediate threat to someone’s safety. This means considering extreme emotions and behaviors, such as self-harm or suicidal thoughts or actions.
If a social worker determines that a child’s life is in immediate danger – considered a “physical emergency” – speedy action needs to be taken. This might include consulting with mental health professionals to arrange inpatient treatment. Alternatively, if they don’t feel like there’s an immediate risk to safety, they may consider arranging outpatient treatment. They will also discuss the findings of their assessment with all involved – including mental health professionals, teens, and parents.
Communicating With Professionals Involved in the Teen’s Care
Regardless of whether a social worker has made a referral to residential or outpatient treatment, they will continuously collaborate with all professionals involved in the child’s care. They may talk to parents about how the teen is coping, update mental health professionals, and discuss progress with teachers and school counselors. Additionally, they may inform first responders about any updates in the referral process.
Importantly, a social worker will work closely with the teenager to help them access resources and consider their opinion on treatment. They understand that the treatment process is not something that should happen to a child, but something they should be included in every step of the way.
Facilitating Treatment
Certain social workers are trained to deliver therapy, such as cognitive behavioral therapy (CBT). Therefore, they can offer short-term counseling to help reduce symptoms of distress – which can be extremely beneficial if a child is awaiting admission to residential treatment. This counseling could be delivered on an individual or group basis, such as involving the family. A social worker may talk to a teen about their wishes for group therapy.
Additionally, social workers can help teens and their families access community-based resources to help them understand what they’re going through and learn healthy coping skills.
Reappraisal
A social worker will likely continue to check in on a child’s progress as they continue through the treatment process. As they are often actively involved in community-based mental health services, social workers are uniquely placed to support a child and their family through recovery. Therefore, they may be able to accurately spot improvements in symptoms – as well as a potential lack of. If a social worker suspects that a teen is “stuck” in their recovery, they may be able to make recommendations for modifications based on their knowledge of the teen’s needs.
Intervening in a Child’s Mental Health Crisis
A mental health emergency in teens is when they show serious disturbances to their emotions and behaviors, or if they present a risk to their own safety or that of someone else. If you’re concerned that a teenager is experiencing a mental health crisis, it’s important not to wait to intervene.8
If you’re worried about a teen’s immediate physical safety, the best course of action is to either take them to your local emergency department or call 911. Let first responders know of your concerns in as much detail as possible, as this can ensure your child receives the exact support they need. The 988 Suicide and Crisis Hotline can also assist you in safeguarding your child.
If your child’s physical safety is not in immediate danger, a mental health professional can talk you through treatment options to protect your child’s emotional and physical well-being. They may discuss the suitability of outpatient or residential treatment for their needs, as well as explain how therapies such as the following can be built into these programs.
Therapy Options for Teen Mental Health:
Cognitive behavioral therapy (CBT): CBT works by targeting teens’ thoughts and actions, identifying negative patterns, and helping them build healthy ways of coping. Social workers may also be able to deliver short-term CBT.
Eye movement desensitization and reprocessing (EMDR): Previous experiences, such as trauma, can seriously affect a teen’s mental health. If this is the case for a teen, a mental health professional or social worker may make arrangements for EMDR. EMDR is an effective way of treating trauma as it changes how these memories are stored in the brain, helping a teen move past trauma and form more positive beliefs.
Interpersonal therapy: A teen’s relationships with family members or friends can contribute to mental health difficulties. A social worker may assess for this and suggest interpersonal therapy. This form of therapy can help teens work through these issues and figure out better ways of coping to improve their mental health.
Transcranial magnetic stimulation: TMS can be effective in treating treatment-resistant mental health conditions. It’s a non-invasive therapy that uses magnetic fields to activate nerve cells in targeted areas of the brain – improving outlook and mood.
Group therapy: Interacting with peers in therapy sessions can help a teen understand that they’re not alone in their experiences, learn healthy ways of coping, and build social support. A social worker can help teens and their families access group therapy as well as support groups.
If your child has not been allocated a social worker, they can still access these therapies. Mental health services can evaluate your child’s needs, discuss the best course of treatment, and connect them to the right sources of care.
When to Seek Help in Handling Mental Health Crises in Children and Teens
If your child is regularly showing some of the signs of mental health concerns listed in this article, the time to seek help is likely now. Mental health conditions can severely affect a teen’s emotional and physical health, as well as their relationships and prospects for the future. What’s more, the longer these conditions go untreated, the worse the symptoms and long-term effects can become. However, you don’t have to handle a teen’s mental health crisis alone – and nor is it advisable to do so.
Mission Prep can help you escalate a mental health concern in children and teens. We offer outpatient and residential treatment options in various locations for teens who are experiencing extreme changes in their emotions and behaviors. Further, our trained team tailors each program to your child’s specific needs, including their opinion on how care is delivered every step of the way. Contact us to learn more.
References
- American Academy of Pediatrics. (n.d.). Interim guidance on supporting the emotional and behavioral health needs of children, adolescents, and families during the COVID-19 pandemic. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/interim-guidance-on-supporting-the-emotional-and-behavioral-health-needs-of-children-adolescents-and-families-during-the-covid-19-pandemic/
- Substance Abuse and Mental Health Services Administration. (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.pdf
- Ezer, T., & Tomasini-Joshi, D. (2021, October 10). First responders with a rights-based approach to mental health crises. Health and Human Rights Journal. https://www.hhrjournal.org/2021/10/10/first-responders-with-a-rights-based-approach-to-mental-health-crises/
- Treatment Advocacy Center. (2019, May 7). Road runners: The role and impact of law enforcement in transporting individuals with severe mental illness. https://www.treatmentadvocacycenter.org/road-runners
- First Aid Training Cooperative. The Role of Mental Health First Responder. https://firstaidtrainingcooperative.co.uk/mhfr-roles-responsibilities/#:~:text=Mental%20Health%20First%20Responders%20can,supported%20in%20moments%20of%20crisis.
- Bunger, A. C., Chuang, E., & McBeath, B. (2012). Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers. Children and Youth Services Review, 34(4), 696. https://doi.org/10.1016/j.childyouth.2011.12.014
- Murphy, S. M., Irving, C. B., Adams, C. E., & Waqar, M. (2015). Crisis intervention for people with severe mental illnesses. The Cochrane Database of Systematic Reviews, 2015(12), CD001087. https://doi.org/10.1002/14651858.CD001087.pub5
- Cleveland Clinic. (n.d.). What is a social worker? What they do & how to become one. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/10417-what-is-a-social-worker
- Cleveland State University. (n.d.). Everything You Need to Know About Mental Health Social Workers. https://onlinelearning.csuohio.edu/blog/everything-you-need-know-about-mental-health-social-workers
