Emergency: If someone is in immediate danger, call 911 now ·
U.S. mental-health crisis: call or text 988
Family Crisis Toolkit
When someone you love is in a mental-health crisis and won't accept help
A practical, U.S.-focused action guide for spouses, parents, partners, adult children, relatives, and close friends helping a loved one who is severely manic, psychotic, suicidal, out of touch with reality, or unsafe — and refusing care. Start by telling us who you're trying to help.
🧑🦱
Age 18 or older
An adult
A spouse, partner, parent, adult child, sibling, relative, or friend who is 18+. Covers emergency holds, civil commitment, medication refusal, financial protection, and hospital advocacy for adults.
Open the adult guide →
🧒
Under 18
A child or teenager
Your own child or a minor in your care. Covers parental consent to admission, the 72-hour hold, what to insist the hospital do, fighting an unsafe discharge, going to a judge yourself, and keeping the home safe.
Open the youth guide →
Educational information only — not medical, legal, or emergency advice, and not a substitute for local crisis professionals. Laws and services vary by state, county, and country. In immediate danger, always call 911 or your local emergency number.
Adult in Crisis (18+)Severe mania · psychosis · unsafe refusal of care
Start here
🚨 What to do in the first 5 minutes
Do not try to win an argument with a delusion. Your goals are safety, calm, documentation, and getting the right crisis system involved.
Call 911 if anyone is in danger right now
Weapons, violence, suicidal or homicidal threats, dangerous driving, fire risk, severe agitation, a medical emergency, or any situation where the person cannot be kept safe. Ask for a Crisis Intervention Team (CIT) officer if one is available.
Call or text 988 for guidance
The U.S. Suicide & Crisis Lifeline can help you decide the safest next step and tell you about local mobile crisis, crisis stabilization, and psychiatric emergency options.
Offer a calm, face-saving path
“Let's get help with sleep and stress tonight.” Avoid labels like “crazy” or “delusional.” You are on the same side.
Move toward the local evaluation pathway
If they refuse and appear unsafe, ask crisis services, the ER, or the county court exactly what to file for an emergency psychiatric evaluation.
⚠️
Crisis behaviors to watch for: no sleep for days · paranoia or delusions · hallucinations · leaving home for days or weeks · unsafe driving · giving large sums of money to strangers · risky online behavior · threats or aggression · refusing food, fluids, medication, or medical care · unable to protect basic safety.
🔒
Privacy tip that surprises most families: Even when clinicians cannot share details with you (HIPAA), you can always give information to them. Write it down and hand, fax, or email it to the hospital, crisis team, or doctor.
🧭 Crisis triage: pick the safest door
This does not diagnose anyone — it helps you choose the safest next action based on what is happening right now.
Red flags
Threats of suicide, homicide, serious violence, or “I can't go on.”
Weapons, physical aggression, fire-setting, barricading, or severe agitation.
Unsafe driving, wandering, disappearing, or trying to leave while clearly impaired.
Psychosis: hallucinations, paranoid beliefs, bizarre fixed beliefs, or responding to voices.
No meaningful sleep for multiple nights with escalating energy, speed, anger, or impulsivity.
Giving away or sending large amounts of money, being exploited, or unable to protect finances.
Refusing medication or all treatment because they do not believe anything is wrong.
Not eating/drinking, not bathing, severe confusion, or inability to manage basic needs.
Substances, medication changes, steroids, stimulants, or medical symptoms may be involved.
🧭
When in doubt, call 988 for guidance, or 911 if immediate safety is uncertain. It is always reasonable to ask for help deciding.
🪜 The four-step action ladder
Work from the least restrictive option toward the most, escalating only as safety requires.
Voluntary help
Use calm language. Offer help for sleep, fear, exhaustion, stress, or safety. Don't argue about delusions. If they agree, go to a psychiatric emergency service, ER, crisis stabilization center, or their psychiatrist.
Crisis response
Call 988 for guidance and ask whether mobile crisis can come to you. Call 911 for immediate danger, violence, weapons, unsafe driving, medical emergency, or if mobile crisis is unavailable.
Legal treatment pathway
If the person refuses care but appears dangerous, gravely disabled, or unable to protect basic safety, ask about your local emergency evaluation, civil commitment, mental-health warrant, probate petition, or assisted outpatient treatment. Names and standards vary by state and county.
Protection & stabilization
Protect money, notify trusted supports, coordinate with hospital staff, request discharge planning, consider guardianship or a mental-health attorney when appropriate, and build a future crisis plan once the person is stable.
☎️ Exact scripts — read them out loud
Calm, specific words for the highest-stakes calls. Tap Copy to keep one on your phone.
Calling 911
“This is a psychiatric emergency. My loved one appears severely manic and/or psychotic. I am worried about safety. There is impaired judgment, possible danger, and inability to stay safe. Please send a Crisis Intervention Team officer or mental-health crisis responder if available. This is a medical/psychiatric crisis, not a criminal situation.”
988 / mobile crisis
“I'm calling about a loved one who appears severely manic, psychotic, or out of touch with reality. They may be refusing treatment and may not recognize they are ill. I need help deciding whether mobile crisis, psychiatric emergency services, an ER, or a court-based evaluation is the safest next step. What local options are available right now?”
Hospital / ER intake
“I need to give collateral information. The person may minimize symptoms or appear calm briefly. Please consider the full recent pattern: sleep loss, severe mood/energy change, psychosis or paranoia, unsafe behavior, refusal of treatment, inability to protect basic safety, and any financial risk. I can provide a written timeline and witness contacts.”
County clerk / court
“I need to ask about the local process for an emergency mental-health evaluation or court-ordered treatment for an adult who may be severely mentally ill, unsafe, and refusing care. What form is required, who can file it, where do I file, what facts are needed, and what happens after filing?”
Talking to the person
“I can see this feels very real and frightening to you. I'm not here to argue. I care about you and I want you safe. I'm worried because you haven't been sleeping and things feel out of control. Would you be willing to go somewhere tonight just to get help with sleep, stress, and safety?”
Bank / scam desk
“A vulnerable family member may have sent money during a mental-health crisis or may be at risk of financial exploitation. Please freeze or review suspicious activity, add alerts where allowed, help us secure accounts, and tell us whether any recent transfers can be reversed, recalled, disputed, or reported.”
⚖️ The legal pathway (for adults)
📌
The honest rule: there is no single U.S. legal process. Emergency holds, civil commitment, medication-over-objection, guardianship, and assisted outpatient treatment are all state-law and county-system processes with different names and standards.
Seven questions to ask your local crisis team, ER, or court
What is the name of the emergency psychiatric hold or evaluation process here?
Can family file directly? If yes, where, and what form?
What facts count — danger to self, danger to others, grave disability, inability to meet basic needs, financial exploitation?
Who can transport the person — police, sheriff, mobile crisis, ambulance?
How long can the person be held before a hearing?
How do we request inpatient commitment or assisted outpatient treatment?
What happens if the person refuses medication?
Option
What it is
When it helps
Limits
Emergency hold / evaluation
Short-term involuntary evaluation when legal criteria appear met.
Immediate crisis, danger, severe impairment.
Usually short; may end without a court filing.
Civil commitment
Court-ordered inpatient or outpatient treatment.
Refusal of care plus danger, grave disability, or other local criteria.
Requires evidence and a legal process.
Assisted Outpatient Treatment
Court-ordered community treatment for some people with serious mental illness and repeated non-adherence.
Cycle of relapse, hospitalization, refusal, or poor engagement.
Availability and rules vary by state/county.
Guardianship / conservatorship
Court-appointed decision-maker for person, estate, or both.
Ongoing incapacity, medical decisions, financial protection.
Not the same as emergency hospitalization; powers vary.
💊 If they refuse medication
What family usually cannot do
Family generally cannot physically force medication at home. Do not hide pills in food, restrain the person, threaten them, or try to overpower them — it can be unsafe and legally risky.
What family can do
Get the person evaluated, provide collateral information, ask clinicians to assess decision-making capacity, and ask what medication-over-objection or court-order process exists locally.
Wording for the treating team
“The person is refusing medication in the context of severe mania, psychosis, lack of insight, and unsafe behavior. Please assess capacity to refuse treatment and tell us the hospital's process for medication-over-objection, emergency medication, or court authorization if clinically appropriate.”
🌱
Once stable, ask about relapse prevention, sleep protection, early warning signs, family involvement, side-effect management, long-acting options when appropriate, and a psychiatric advance directive.
🔒 Financial & digital safety
Mania can create real-world financial danger — sending large sums to strangers, risky investments, romance scams, impulsive purchases, shared passwords, or giving away personal information.
Same-day actions
Call banks and credit-card companies.
Ask about freezing cards, fraud alerts, transfer recalls, and unusual-activity blocks.
Change passwords if accounts may be compromised.
Preserve screenshots and receipts.
Report
Report scams to the FTC at ReportFraud.ftc.gov.
Report internet/cyber fraud to the FBI IC3 at ic3.gov.
File a local police report when money, identity, or exploitation is involved.
Protect going forward
Ask about daily transfer limits.
Freeze credit if there is identity risk.
Consider legal advice about joint accounts, power of attorney, guardianship/conservatorship, or protective orders where appropriate.
🗣️ How to talk without making it worse
✅ Use this approach
Listen more than you talk.
Reflect the emotion, not the delusion.
Find shared goals: sleep, safety, fear reduction, dignity.
Offer choices: “ER or crisis center?” “Now or after we pack a bag?”
Keep your voice low, body relaxed, exits clear.
🚫 Avoid this
“You're crazy.”
“That never happened.”
Long logical debates.
Mocking, shaming, cornering, grabbing.
Threats — unless required for safety.
Goal
Say this
Listen
“Help me understand what feels most frightening right now.”
Empathize
“That sounds terrifying. I can see why you feel unsafe.”
Agree
“We both want you safe and able to sleep.”
Partner
“Would you let me help with the next step so tonight is calmer?”
🏥 How to advocate at the ER or psychiatric hospital
Before arrival
Bring ID, insurance, and medication bottles/list.
Bring your written timeline and evidence.
Bring screenshots, bank records, texts, or police reports if relevant.
List medical conditions, allergies, substances, and recent medication changes.
At intake
Ask how to submit collateral information.
Warn them the person may “hold it together” briefly.
Ask the team to weigh recent behavior over days/weeks — not just the calm moment.
Ask about discharge criteria and next steps if they refuse voluntary admission.
Before discharge
Ask for a written safety plan.
Ask about medication, the follow-up date, and a crisis number.
Ask what to do if symptoms resume tonight.
Ask about PHP/IOP, case management, AOT, or community mental-health services.
🔒
HIPAA reality: the hospital may not be able to tell you everything, but you can still give information, ask general questions, and ask how family can be included if the patient allows or lacks capacity.
🧬 Do not miss medical causes
Severe mania or psychosis can be part of bipolar disorder — but medical issues, substances, medication reactions, neurologic and endocrine problems, infection, and sleep deprivation can look identical. This matters most when symptoms are new, late in life, unusually abrupt, confused/delirious, or medically complicated.
Ask the clinicians
“Because these symptoms are severe and may include mania or psychosis, please evaluate for medical, medication-related, substance-related, neurologic, endocrine, infectious, and sleep-related causes. Please don't assume it's only psychiatric until reasonable medical causes are considered.”
Stimulants · steroids · antidepressantsSubstances · withdrawal · med errorsFever · infection · dehydrationHead injury · new neurologic signsThyroid / endocrine changesFirst episode after midlife
🧩 After the crisis: build a safer future
Relapse-prevention checklist
Identify early warning signs: less sleep, rapid speech, spending, irritability, paranoia.
Agree on who can call the psychiatrist or family.
Create a medication and sleep-protection plan.
Discuss financial-safety limits during episodes.
Make a written crisis plan or psychiatric advance directive if available in your state.
🤝
Caregivers need support too. Look at NAMI Family-to-Family, NAMI family support groups, DBSA groups, therapy for caregivers, and community case management. Burned-out families make harder crisis decisions — support is part of treatment.
📚 Resources
988 Suicide & Crisis Lifeline
Call, text, or chat 988 in the U.S., 24/7, for crisis support and local resource guidance.
Child or Teen in Crisis (Under 18)Parents & guardians · hospitalization · refusal of care
Start here — you have more authority than you think
🚨 The first 5 minutes with a child or teen
The single most important thing to know up front: as a parent or legal guardian, you can consent to your minor child's evaluation and treatment. With an adult you often need a court; with your own child under 18, the law gives you the lever. Your goals right now are safety, calm, and getting them in front of someone who can evaluate a minor.
If anyone is in danger right now, call 911
Weapons, a suicide attempt in progress, violence, or a child bolting into traffic. Say the words “psychiatric crisis” and ask for a Crisis Intervention Team (CIT) officer or mobile crisis responder if available — you want a mental-health response, not an arrest.
Call or text 988 for guidance
The Suicide & Crisis Lifeline can help you decide the safest next step and point you to youth mobile crisis and pediatric options near you.
Go where a child can actually be evaluated
A children's hospital ER or a pediatric psychiatric intake / crisis program is far better than a general adult ER. Many children's hospitals have a dedicated crisis “front door” (see Resources).
Bring the paperwork that makes your case
ID, insurance, a medication list, and — most important — a written, dated timeline of the dangerous behaviors you've seen. This is what stops a calm 20-minute exam from undoing weeks of crisis.
⚠️
Dangerous signs in a young person: a suicide attempt or a detailed plan · giving away belongings · self-harm · threats to kill themselves or someone else · violence or destroying the home · running away or disappearing · psychosis (hearing voices, paranoia) · not sleeping with racing, escalating behavior · heavy drug or alcohol use · searching online for methods of self-harm.
👪 Why a minor is legally different from an adult
This is the part most parents don't know — and it changes your whole strategy.
You have two doorways, and you control one of them
There are two legal ways a young person enters a psychiatric hospital: voluntary admission (which a parent/guardian can initiate) and involuntary/emergency admission (initiated by the state — clinicians or police — based on danger). With an adult, families are usually stuck waiting on the involuntary track. With your own minor child, you can often authorize a voluntary admission yourself.
⚖️
The key case — Parham v. J.R. (U.S. Supreme Court, 1979). Parents may voluntarily admit a minor for psychiatric care without an adversarial court hearing, and generally even over the child's objection. The only constitutional safeguard required is that a “neutral fact-finder” — usually the admitting physician, not a judge — independently agrees the child needs it. In plain terms: your signature plus a doctor's agreement can get your child admitted.
But older teens may get a say — and it varies by state
Many states give a minor the right to object to or consent to their own psychiatric admission once they reach a set age — commonly 14 or 16. If your teen is over that age and objects, the case can shift onto the involuntary/court track. This threshold is different in every state, so confirm it locally.
“In our state, at exactly what age can my child legally consent to, refuse, or object to psychiatric admission — and has my child reached that age?”
“If my child objects, who reviews that here — the admitting physician, a review panel, or a judge — and is a court hearing automatic?”
Adult (18+)
Child / teen (under 18)
Who can authorize admission
The adult, or a court. Family usually cannot.
You, the parent/guardian can consent to a voluntary admission (with a physician's agreement).
Refusing treatment
A competent adult can refuse.
A younger child cannot override a parent; an older teen may gain a right to object (state-specific age).
Emergency hold length
Varies (often ~72 hrs).
Varies — e.g., Ohio ~3 court days; Kentucky up to 7 days for minors (excluding weekends/holidays).
To hold longer
Court petition + hearing.
Same — a judge orders it, and a parent can be the person who files.
Names, ages, and timelines below are examples to verify where you live — mental-health law is state-specific and changes.
🏥 At the ER: be the collateral, defeat the “calm snapshot”
Emergency clinicians are trained to decide from several sources — not just the child's word. Your job is to make sure the record reflects the pattern, not a calm moment.
📋
The calm-snapshot problem. Hours into a safe, locked unit, a child often looks fine and may deny any suicidal thoughts — sometimes specifically to get discharged. National child-psychiatry guidance is explicit that a young person should never be discharged from the ER without the caregiver having verified the child's account. That's your opening — use it.
Bring and hand over a written packet
A dated timeline of specific incidents — concrete beats general: “punched through the door and threatened his sister on the 3rd; found searching how to overdose on the 5th” beats “he's been aggressive.”
Direct quotes and actions the child may now be minimizing.
Prior attempts, hospitalizations, self-harm, running away, diagnoses, and current treaters.
Current medications, doses, adherence, allergies, recent changes; any substance use.
Access to lethal means at home — firearms, ammunition, medications, sharps, car keys.
Insist these be done and documented
A standardized suicide-risk assessment (ask if they use the Columbia / C-SSRS) that incorporates your collateral.
Consideration of the full recent pattern, not just the current presentation.
Medical rule-outs (see below) and a psychiatric medication evaluation.
Evaluation of the right level of care — inpatient, residential, partial hospitalization, or intensive outpatient.
Script — handing over collateral
“I want to give you collateral information the team should have on the chart. Here is a written, dated timeline of the behaviors I've seen at home. I'm concerned my child may present calmly and minimize what's been happening, so I'd like these specific incidents documented as part of the risk assessment. Whose name should I put on this so I know it reached the treating clinician?”
Script — say the concern for the record
“I understand he's telling you he's fine and denying any thoughts of hurting himself. I need you to know that at home, within the last 48–72 hours, he did the following… I'm worried a snapshot in this setting doesn't reflect the pattern. Can you confirm the team is weighing the recent history and my report, not only his current statements?”
🛏️ Getting them admitted — and to the right level of care
Ask directly about a parent-consented voluntary admission. If the team agrees clinically, your signature may be enough — no court needed. If your child is old enough to object in your state and does, or if the team resists, you move toward the involuntary pathway (mental illness plus danger to self or others, and often “least restrictive setting”).
🪜
“Not sick enough for inpatient” must never mean “nothing.” There's a whole continuum — residential → partial hospitalization (PHP, all day, home at night) → intensive outpatient (IOP). If they won't admit, ask which step-down level they are recommending and how quickly it starts.
Questions worth asking before admission
Who will be my child's psychiatrist, and how often will I be updated?
What's the expected length of stay, and what are the goals for discharge?
How will I be involved in treatment and discharge planning?
What happens if our insurance denies coverage but treatment is still needed?
What aftercare — PHP, IOP, outpatient — will be arranged before discharge?
The situation you described — read this closely
🛑 They want to discharge. You know it isn't safe. What to do.
The hold is ending, your child is denying everything, the team is talking discharge — and you're certain they're still dangerous. Here is the playbook. Several of these can run at the same time. Stay firm, specific, and collaborative; write down every name, time, and answer.
Get the attending psychiatrist — and get the reasoning documented
You're often talking to a resident, nurse, or social worker. Ask that the attending psychiatrist explain the decision and document the risk rationale in the chart. Forcing that documentation makes the team actually engage your collateral, and it creates a record.
Ask them to pursue court-ordered continued treatment
If you believe your child still meets criteria — mental illness plus danger — ask the hospital to file for continued involuntary treatment. Be honest with yourself about the limit: you can request it and supply evidence, but a physician must certify and a judge decides. (If they won't, you may be able to file yourself — see “Going to a judge.”)
Separate the insurance decision from the safety decision
A hidden driver of early discharge is an insurer refusing to pay for more days. That is not a medical finding that your child is safe. Ask point-blank whether discharge is clinical judgment or a coverage decision. If it's coverage: ask the doctor to request a peer-to-peer review today, and file an expedited/urgent appeal (decisions often within ~72 hours) while your child stays admitted.
Ask for a second opinion or a transfer
Child-psychiatry guidance explicitly tells parents they may ask for a second opinion. If you're in a general/adult ER, ask about transfer to a facility with a child & adolescent psychiatric unit or a higher level of care.
If they discharge anyway, force a real written safety plan
Do not leave without it — a follow-up appointment already scheduled within ~7 days (not just a phone number), written warning signs, exactly who to call in a crisis (988 + local mobile crisis), a lethal-means removal plan, and a supervision plan. Ask that your stated disagreement be noted in the record.
🧯
“I can't keep him safe at home” — use with care. Saying you cannot safely supervise your child is important clinical information and should factor into the decision. But a flat refusal to take your child home can, in some states, be treated as a “lockout” and referred to child protective services as neglect. Don't frame it as refusal. Frame it as a safety gap you need help solving — and ask a hospital social worker to problem-solve it with you.
Script — attending + documented rationale
“I'd like to speak directly with the attending psychiatrist making the discharge decision — not only the resident or social worker. I'm asking them to document in the chart the specific risk assessment and the reasoning for why discharge is safe today, given the collateral I've provided. If they've concluded he's safe, I want that judgment, and its basis, in the record.”
Script — insurance vs. clinical
“Is this discharge based on your clinical judgment that he's safe, or on an insurance coverage decision? If it's the insurer, I'm asking the attending to request a peer-to-peer review today and keep him admitted while medical necessity is argued. A payment denial isn't a determination that he's safe to come home. I'm also filing an expedited appeal because his health is in serious jeopardy.”
Script — pursue commitment / on the record
“It's my position that my child still meets criteria for involuntary treatment — mental illness plus danger to himself or others, based on the behaviors I've documented. If the team agrees, I'm asking you to file for continued hospitalization. If the team disagrees, please document that you evaluated him against the criteria today, concluded he doesn't meet them, and explain why.”
If internal escalation stalls, the ladder inside a hospital is: bedside nurse → charge nurse → social worker → attending → unit medical director → patient advocate / patient relations / risk management → formal grievance. Outside oversight includes the hospital's accreditor and your state department of health — but those handle complaints, they won't reverse a single discharge in real time, so work the internal ladder first.
⚖️ Going to a judge yourself
Here's the answer to your question about the judge: yes, holding a child past the emergency period is decided by a judge — and in many states a parent can be the person who starts that process.
Continued hospitalization beyond the emergency hold isn't ordered by the hospital or by you — it's ordered by a court, after a hearing, on a heightened standard of proof (“clear and convincing evidence”). What you can do is trigger that court review by filing a petition/affidavit, and testify to what you've witnessed.
Example (verify locally)
Who can file to continue a hold
How long / standard
Ohio (Rev. Code 5122)
An affidavit may be filed in probate court by “any person” — which includes a parent — or by the hospital's chief clinical officer.
Emergency “pink slip” ≈ 3 court days; then a court hearing; commitment on clear and convincing evidence.
Kentucky (minors: Rev. Statutes ch. 645)
A petition may be filed in District Court by “any interested person” (including a parent) or the hospital.
Emergency hold up to 7 days (excl. weekends/holidays) unless a certification petition is filed; then a hearing; clear and convincing.
A petition/affidavit generally must state specific facts showing probable cause that the child, because of mental illness, is a danger to self or others (and often that hospital treatment is the least-restrictive option that helps), plus a clinician's certificate or a statement that the child refused examination.
📞
Call your county court before you need to. Ask for the probate court (Ohio) or District Court / mental-health docket (Kentucky), or your county's equivalent elsewhere. A script is in the Resources sheet below.
🚫
What not to do: don't try to criminalize your child to force help, and don't use unsafe physical force. When you must call 911, ask specifically for a Crisis Intervention Team (CIT) officer so it's handled as a health crisis, not a crime.
☎️ Phone scripts — keep these on your phone
Calm, specific words for the calls where it's hardest to think. Tap Copy.
Calling 911 for your child
“This is a psychiatric emergency involving my child. He's a danger to himself and can't be kept safe. Please send a Crisis Intervention Team officer or mental-health crisis responder if available. This is a health crisis, not a crime. I want him taken to a hospital that can evaluate a child for psychiatric care.”
988 / youth mobile crisis
“I'm the parent of a minor in a mental-health crisis. He may be suicidal or out of touch with reality and he's refusing help. I need the safest next step — whether a youth mobile crisis team can come to us, or which pediatric psychiatric emergency/crisis center we should go to right now.”
Calling the county court clerk
“I'm a parent trying to get emergency psychiatric help for my child under 18 who is mentally ill, dangerous, and refusing treatment. What's the process here to petition for a court-ordered evaluation or continued hospitalization for a minor — which court handles it, can a parent file, what form is required, what facts do I include, and what happens after I file?”
Talking to your child
“I love you and I'm not angry with you. I'm scared because of what's been happening, and my only job right now is to keep you safe. I'm not trying to punish you. We're going to get help together, tonight, so you can feel better and sleep.”
🔒 Make the home safe — this is the part that saves lives
Youth suicidal crises are often impulsive — the time from decision to act can be under 30 minutes. Removing access to lethal means during the high-risk window is one of the very few steps proven to save a child's life. Child-psychiatry guidance is blunt: parents must be told directly to do this, because most won't on their own.
Firearms: the safest option during a crisis is to remove them from the home entirely — store them with a relative, friend, or a police station/gun shop that offers storage. If any remain, lock them unloaded, store ammunition separately and locked, and keep keys/codes off-limits.
Medications: lock up all of them — prescription and over-the-counter. Ordinary painkillers like acetaminophen (Tylenol) and aspirin can be lethal in overdose. Keep only small quantities out; lock or remove the rest.
Alcohol and any drugs — lock or remove.
Sharps and ligature risks — secure razors, knives, and reconsider access to ropes, belts, cords during the acute period.
Car keys — control access if there's any risk of unsafe driving or leaving.
Supervision — agree on who watches the child and when, especially nights and the first weeks after any discharge.
✅
This isn't punishment and it isn't forever — it's reducing risk during the dangerous window. You can tell your child exactly that.
🧬 Don't let anyone skip the medical work-up
New psychosis, mania, or a sudden, dramatic behavior change in a young person can come from medical, substance, medication, neurologic, endocrine, infectious, or sleep-related causes — not only a primary psychiatric illness. This matters most when symptoms are new, abrupt, or accompanied by confusion or physical symptoms.
Ask the clinicians
“Because these symptoms are severe and new, please evaluate my child for medical, medication-related, substance-related, neurologic, endocrine, infectious, and sleep-related causes — including a toxicology screen if appropriate. Please don't assume it's only psychiatric until reasonable medical causes are considered.”
🧩 After discharge — and getting school on your side
The first days home
Confirm the follow-up appointment is within about 7 days — the highest-risk period is right after discharge.
Keep the written safety plan visible: warning signs, coping steps, who to call, and the crisis numbers.
Keep lethal means secured (see above).
Watch for warning signs: withdrawal, giving things away, sleep collapse, agitation, hopeless talk.
Step-down care
Ask whether your child should step down through a partial hospitalization program (PHP) or intensive outpatient program (IOP) rather than jumping straight to occasional outpatient visits.
School re-entry & your child's rights
Your child may qualify for formal school support through a 504 Plan or an IEP (special-education services) for a mental-health condition. Request a re-entry meeting and accommodations in writing.
“I'd like to request a 504 plan / IEP evaluation for my child's mental-health condition — who coordinates that and what's the timeline?”
“Can we set up a re-entry plan: a point person, a safe place to go if overwhelmed, and a plan for missed work?”
🤝
Parents and siblings need support too. NAMI's programs for families of youth (below), your own therapist, and caregiver support groups aren't extras — they're what keep you steady enough to make good decisions.
🎂 The 18th-birthday cliff — plan for it before it arrives
The authority you have as a parent to consent to treatment, see records, and drive decisions generally ends the moment your child turns 18. At 18 they're an adult in the eyes of the law — you'll no longer automatically get information or a say, even if they're still very ill. If your child is approaching 18, plan ahead:
Ask the treatment team to have your child sign a release of information (ROI) naming you, and consider a healthcare power of attorney and a psychiatric advance directive while they're stable and willing.
If there's serious, ongoing incapacity, ask an attorney about guardianship of an incapacitated adult — but know the bar is high and it takes time, so start early.
Once they're 18, your leverage shifts to the adult pathway — see the adult guide.
📚 Resources for families of a child or teen
988 Suicide & Crisis Lifeline
Call, text, or chat 988 — 24/7, all ages. You can call about your child even if they won't.
Family info & referral — not a crisis line. Call 1-800-950-6264 or text “NAMI” to 62640 (Mon–Fri, 10a–10p ET). NAMI Basics is a free course for parents/caregivers of youth.
Greater Cincinnati (OH/KY). Psychiatric Intake Response Center — the “front door” to child psychiatry: 513-636-4124. After hours the line pages the on-call clinician (callback within ~1 hour); for immediate danger use 911 or 988.
Columbus, OH. Walk-in psychiatric crisis department for children — “like an ER, but for a mental-health crisis.” Franklin County Youth Psychiatric Crisis Line: 614-722-1800.
Louisville, KY. Child/adolescent behavioral health: 502-588-0800; general line 502-629-KIDS (5437). Inpatient care is typically accessed through the emergency department.