Children's Hospital Colorado

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

An adolescent boy and his father sit outside together while having a conversation.

Long before the pandemic disrupted our way of life, pediatricians noticed rising anxiety, depression and even suicide in kids. Since COVID-19 interrupted the routines and support structures that kids rely on, mental health needs have skyrocketed, prompting Children's Hospital Colorado to declare a state of emergency for youth mental health.

While no parent or caregiver wants to think about their child harming themselves or taking their own life, it’s important to know the signs and be prepared. We talked with Dru Hunter, LSCW, and Lauren Wood, PhD, two of our on-call pediatric mental health experts, to help you understand what crisis warning signs to look for by age group and how to determine the level of mental health support your child needs.

Here’s what you need to know to help you quickly evaluate if your child could be in crisis – and what to do next.

First, what is a mental health crisis?

A mental health crisis is any situation in which a person’s behaviors or symptoms put them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively.

For example, when a child or teen is in such distress that they experience major changes to eating or sleep or can’t get through a school day, they are often in or approaching a mental health crisis. A mental health crisis may or may not include thoughts of suicide.

When a pediatric mental health crisis involves the risk of suicide or violence

When we talk about an acute mental health crisis or a mental health emergency that requires immediate evaluation and care – such as a trip to the emergency department or a call to 911 – we are referring specifically to youth who are likely to be an immediate danger to themselves or others.

Any talk of suicide (injuring oneself with the intent to die), homicide (killing others) or committing violence against others should be taken seriously. When a person is in crisis and they are suicidal or homicidal, that becomes a mental health emergency.

What about a pediatric mental health crisis that may not include suicidal thoughts?

Generally, your child may be in crisis (or building towards a crisis), but not necessarily suicidal if they:

  • Talk about wanting to die or being “better off dead:” a sign of hopelessness and severe depression
  • Experience a change in ability or motivation to perform daily functions, such as proper hygiene or eating and sleeping
  • Show additional signs as outlined by age group, below

Record numbers of children in crisis

Unfortunately, experts in our Pediatric Mental Health Institute are seeing children as young as 8 coming to the emergency department because of suicidal thoughts, and visits to our emergency departments for mental health crises have increased. As children get older, the rate of severe depression (and therefore risk of crisis) increases. Most people who attempt suicide have shown signs or warnings, but not always. Children and adolescents who are in crisis are at higher risk of suicide, so pediatric psychologists advise caregivers to remain alert if a child is in crisis or could be building towards one.

“Our ability to predict who will act on suicidal impulses isn’t perfect — there are a lot of variables,” Dr. Wood says. “Use these guidelines and also trust your gut because you know your child and you know what’s normal for them.”

Signs of a mental health crisis by age group

Signs of a mental health crisis can depend on the individual and your child’s age. Signs of a crisis may be obvious in some children but more subtle for others. Remember, you know your child best.

What should I do if I think my child is in crisis or building towards a crisis?

If you notice signs of worsening mental health in your child or that they are in or approaching a mental health crisis but are not at risk of suicide, now is the time to increase mental health support.

“Let’s catch that crisis early,” says Dru. “It becomes more challenging when a child escalates from being in crisis – like experiencing severe depression, hopelessness and feeling like they would be ‘better off dead’ – to suicidal ideation – having more specific thoughts or plans about killing themselves and/or extreme disregard for their own safety.”

Additional questions about kids in crisis

You are not alone. If you or someone you love are currently experiencing thoughts of self-harm, or even if you just need to talk, please call a crisis line now:

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