Where to Send Kids in Crisis (Other than 911)

It’s every caregiver’s nightmare: a child in crisis, and no clear path to the right help. For too long, families have been funneled into a system that treats mental health emergencies like broken bones—sending kids straight to the ER or calling 911. But ERs aren’t built for mental health care—many lack specialized psychiatric staff, leading to long wait times and inadequate treatment. Additionally, police involvement can escalate distress, making an already difficult situation even more traumatic for children in crisis. The good news? There are better options. The challenge? Many people—parents, pediatricians, even other healthcare professionals—don’t know where to turn.

Let’s break down the different levels of acute mental health care for kids, what they’re for, and when they should be used.

Outpatient Care: The Starting Point

Outpatient therapy is where most families begin, often through referrals from pediatricians, insurance directories, or school recommendations. It’s designed for mild cases—think low-level anxiety, mild depression, ADHD. This is for kids who don’t need close monitoring and can function in daily life with support from therapy and, in some cases, medication. But it’s not enough for more severe symptoms, and when outpatient care isn’t cutting it, we need to look at the next steps.

In-Home Therapy: When Family is a Key Factor

In-home therapy is an option for kids whose struggles are deeply tied to home life—whether it’s family dynamics or behavioral challenges that only show up at home. These services provide more intensive support, often after a crisis, to prevent further escalation. But in-home therapy is typically reserved for more severe cases and isn’t always widely available.

Day Treatment: Bridging the Gap at School

Day treatment programs come in two forms:

1. School-Based Programs – For kids with behavioral issues at school who may have a 504 plan or IEP that isn’t working. These programs run for several hours a day, five days a week, over about nine months. The goal? Keep kids out of alternative schools and help them manage behavior.
2. Intensive Outpatient Programs (IOP) – Three hours a day, three days a week. This is for kids whose mental health symptoms are interfering with daily life—maybe they’re missing school, struggling with hygiene, or having frequent thoughts of self-harm. This level of care is far more effective for conditions like moderate-to-severe depression than traditional outpatient therapy alone.

Partial Hospitalization: One Step Before Inpatient

Partial hospitalization programs (PHP) operate five days a week for about six hours a day. Kids in these programs are at significant risk—perhaps experiencing suicidal thoughts or self-harm but not requiring 24/7 supervision. They receive intensive therapy, medication management, and schooling to keep them on track.

Residential Care: When Kids Need to Stay Overnight

There are two types of residential care:

1. Unlocked Residential Treatment – A live-in program for kids who have cycled through acute care and need a structured environment to stabilize.
2. Locked Residential Treatment – A more intensive setting for those at high risk of harming themselves or others. Kids here receive daily therapy, medication management, and structured routines to help them regain stability.

Inpatient Psychiatric Care: The Highest Level of Urgency

Inpatient hospitalization is for kids at immediate risk—those who are suicidal with a clear intent or plan, experiencing psychosis, or exhibiting severe violence. But here’s the thing: inpatient care isn’t treatment. It’s stabilization. The goal is to keep the child safe, adjust medications, and figure out the next step in the treatment plan. ERs work similarly—triage, not treatment. That’s why understanding and utilizing other levels of care is so critical.

Mobile Crisis Teams: A 911 Alternative

Calling 911 for a mental health crisis often leads to unnecessary hospitalization or law enforcement involvement, which can escalate the situation. Instead, many areas now offer mobile crisis teams—social workers who come to the home, assess the situation, and connect families with appropriate care. These services are county-based, usually managed through the Department of Health and Human Services, and a much better first step than the ER in many cases.

The Caregiver Conundrum: What to Do When Medication is Being Requested

Caregivers often go to their pediatricians for everything, but also often expect those pediatricians to essentially slap a bandaid on the problem, i.e., prescribe medication. When faced with a frustrated and desperate caregiver, sometimes medication does feel like the fix—but if it feels like a quick fix, then remember to pause. 

Good care starts with primary care. A child’s pediatrician has the best understanding of that child’s history, environment, and home life. It is that very expertise that can drive real change in the child’s life. 

Take Action

If you’re a provider, make it a priority to understand the mental health resources available in your community. Start by checking state mental health directories, professional networks, or hospital-affiliated programs to get a comprehensive view of available services. If you’re a parent, advocate for your child by asking about all options—not just outpatient therapy or the ER. Mental health care isn’t one-size-fits-all, and knowing where to go can make all the difference.

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