A Safety Plan for Mental Health Emergencies

Four weeks ago Sunshine began the process of slowly weaning off of one of her mood disorder medications as recommended by her developmental pediatrician.  We had hoped the weaning process would go well, but the opposite occurred.  Our family found ourselves in the middle of a mental health emergency where we had to initiate our safety plan protocol.

This is only the second time that we have had a mental health emergency in our home.  It's the second time we've had to put our planning to the test and hope that everyone stays safe.  Words can not express how thankful I am for the time we spent putting together a safety plan.  We knew there was a good chance a mental health emergency may occur.

Knowing our family is not the only one that finds itself in this scenario my husband and I have decided to share our experience and a safety plan for a mental health emergencies.  Please know this post is filled with raw emotional content and may be disturbing to some, especially those who may not have experience with mood disorders in children.

A safety plan for pediatric mental health emergencies
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A Plan Gone Wrong

The plan was for Sunshine to wean off of her medication, reducing the amount by .25 ml each week until finished.  At first we thought things were going okay.  We noticed extra irritability and some defiance but attributed that to withdrawal and typical control battles common with Sunshine.  As planned, we called our developmental pediatrician's office and reported how the first week had gone.

The second week didn't go as well.  We noticed rages and extreme defiance.  Sunshine was becoming physically aggressive.  However it was a crazy week.  My father had surgery and my mother stayed with us.  Daily routines and schedules were changed up, which Sunshine struggles with mightily.  We couldn't be sure behaviors were a result of weaning medication or changes in routine. It was decided to wait another week before reducing the dose again.

It only took three days after reducing the dose another .25 ml to know with certainty that things were not okay.  The rages and physical aggression ramped up to crazy levels.  Sunshine stopped sleeping all together.  She was insanely loud.  And there was this drive to go.  If you tried to interfere or stop her, BEWARE!

It was a Monday when everything came to a head.  Sunshine couldn't be reasoned with.  She was not functioning.  What would normally be a calm exchange of words turned violent.  Sunshine started to throw any items she could get her hands on.  She even threw a dining room chair, almost breaking a window.  And then she verbally threatened to kill me with a knife.

That's when I knew, my dear sweet Sunshine was horribly manic.  She had become a danger to herself and to others.  The medicine had been working more than we knew.  We were in trouble.  I had to initiate our safety plan.

A Safety Plan for Mental Health Emergencies


1.  Immediately remove others from harm's way

Your first instinct may be to go to the child who's having the mental health emergency and help her, but your first priority is to make sure that you and any others who are present are safe.  Remember how important it is to put an oxygen mask on yourself in an airplane emergency, before helping the person beside you?  The same rule applies here.

In our home, all sharp objects are locked up.  I knew that even though Sunshine wanted to kill me with a knife, she did not have access to sharp objects, so I was safe.  If you don't have sharp objects locked up in your home and you have a child with mental health issues, decide to lock them up before something happens, not after.

I am a minimalist by nature and so there are very limited objects that Sunshine can throw at any given time.  Everyone in the house knows we can't leave things laying around for this very reason.  If Sunshine breaks a window, she knows the safety protocol for that.

My biggest worry was that she'd try to attack one of her siblings.  Though she's the youngest, she is big for her age and very strong.  Combine the strength and extra energy that comes with a manic episode... The safety of others is always our biggest concern.

My husband Jason is home full time for this very reason.  It's part of our safety plan.  One of us takes the lead with Sunshine.  The other attends to the rest of children, removing them when necessary to ensure everyone stays safe.  On this day, my husband was already gathering the other kiddos outside to play.  I was taking the lead with Sunshine.

2.  Stop the child from endangering herself or others

If you are dealing with a child who is having a mental health crisis you want to follow prepared steps to deescalate the situation if possible.  When these steps don't work, safety comes first.  Steps used to deescalate the situation should be prepared ahead of time and approved by doctors and specialists.  Most often these professionals will help in the planning process.

We have learned that the only way to stop Sunshine when on the rampage is to grab her and hold her until she is finished raging, and becomes calm and rational.  Depending on the situation and how manic she is, this can take anywhere from 20 minutes to over an hour.

My husband and I have tried every other method imaginable, so as to not have to restrain her in any way, but none have worked.  We have spoken with our developmental pediatrician about everything.  She has seen Sunshine at her worst and witnessed the violence.  During appointments when Sunshine is out of control, the developmental pediatrician has sat with me as I've held Sunshine, witnessing the fight and screaming.

It's documented in Sunshine's charts that when she becomes unsafe, we are to grab her and hold her until she is okay.  Sunshine knows this also.  She knows we will let go when she can be still, kind, and quiet for five minutes.

I can not express to you how much physical, mental, and emotional energy it takes to hold a child who is kicking, screaming, and fighting to get away.  All a parent wants to do is help their child feel better and make everything okay.  But when a child is manic, this is rarely ever possible.  I cry every single time I have to hold Sunshine in this way.  Every.  Single.  Time.

If you can not calm your child, your child is too big to hold safely, or is being violent towards another person you may need to call law enforcement or other support for help with this process.  In some cases your doctors may recommend calling law enforcement instead of holding your child.  Follow the advice of your medical professionals.

3.  Call and report

Once the child is calm and safe, immediately call your doctor or other specialist to report the incident.  You may also want to document it in a notebook for your own purposes.  This process helps your child.  Doctors and specialists are made aware of behaviors as they happen, which helps them create a better treatment plan for the child and builds trust in their relationships with you as the parent.

Reporting incidents and keeping your own documentation also protects you as a parent.  Everyone involved knows you're doing everything in your power to help your child and keep all family members safe.  If a concerned neighbor or other person unfamiliar with the situation calls law enforcement, you will have everything you need to work through any process that may result from that.

After Sunshine was calm, I immediately called her developmental pediatrician's office, explaining the scenario.  A nurse called back within the hour asking for more details.  She conferred with the doctor and an appointment was scheduled for two days later.  The nurse asked if we had a safety plan to help get everyone through until we could meet with the doctor.  I shared details and it was documented.

4.  Lower expectations

During a medical emergency, there's a chance that concerns can be addressed immediately and the problem is resolved.  Other times treatment and recovery take time.  In situations regarding mental health, there is no quick fix.  Whether it's waiting for a doctor's appointment, medication, or another course of treatment, you will probably find yourself waiting with a child who is unsafe.

It's during these times that you must lower expectations of your child, other family members and yourself.  Your primary concern is keeping everyone safe.  If rage, physical aggression, or violence can be avoided, you do it, even if that means your child is watching their favorite tv show or playing their favorite video game the entire day.  You want to keep your child calm.

All other obligations and responsibilities are delegated out when possible or cancelled all together.  If you're able to provide safety, support and consistency for other family members do it.  When that's not possible, ask for help.  You can not do this on your own.

My husband and I knew we could keep everyone in our family safe because of plans already implemented in our home and because both of us are home full time.  We knew we could do nothing else outside of our child care responsibilities, so we asked for help in any way people could provide it.  Meals were brought in.  People ran errands for us.  Whatever we needed, people responded to the call.

5.  Follow through with recommendations made by doctors and specialists

Once you have reported the incident, it is extremely important to follow through with any recommendations made by doctors and specialists immediately.  The sooner your child is stabilized the better.

Following through with recommendations is also a great way to protect yourself as the parent and build trust with professionals.  You will need these professionals to advocate for your child and for you.  They need to see you're doing your part.

Sunshine's developmental pediatrician's office is about 90 minutes from our home. This isn't too bad, except in the winter, when there is snow.  My husband and I watched the weather which appeared to be in our favor up until the day of our appointment.  There was a Lake Effect Snow Advisory that would begin two hours before our appointment and last all the way through until the next night.

Knowing we couldn't miss the appointment, we packed everyone up as soon as possible and booked a suite in a hotel for two nights less than five minutes from the hospital.  Sunshine had another appointment at the same hospital the very next day.  This had been scheduled months in advance.  All six of us stayed together to avoid any unnecessary triggers for Sunshine due to separation.

My husband took Sunshine to her appointments while I remained at the hotel with the other kiddos.  The developmental pediatrician couldn't believe how manic Sunshine was and told us to immediately increase the dose of her medication back up to where it was before problems began.  Effects of the increase wouldn't be seen for about a week, but at least it was something.

She then prescribed another mood disorder medication in hopes that with all medications at work we could stabilize Sunshine.  The new medication needs to gradually increase and build up as to avoid severe side effects.  This means that we won't reach a therapeutic dose for some time, but we're continually working on it.

Recovery and Healing

It's been a week since Sunshine turned violent and five days since our appointment with the developmental pediatrician.  We've started to see improvements today, but she's still manic.  Expectations continue to be low to avoid further issues.  Extra supports are still in place and needed.  We are hoping by the weekend she is doing better.

Though exhausted, my husband and I are filled with gratitude and counting our blessings.  Safety plans had been set up ahead of time and they worked.  No one was hurt.  Everyone is safe.  Sunshine is still with us, and for that we are thankful.  We love our daughter and are willing to do whatever we can to keep her happy, healthy, and safe.

Sunshine did not ask to have a mood disorder.  She can not control when she has manic episodes.  As her parent, I can help her. I can advocate for her.  I can fight for her.  She needs that and deserves nothing less.  This is not her fault.  And so I fight.  My husband fights.  We will do all we can to help her live the best life possible.

If you enjoyed this post, you may also enjoy the posts below.
How to recognize signs of a mood disorder in young children

How to prepare for an appointment with a developmental pediatrician

I think there's something wrong with my child: A  guide to pediatric specialists

Mood disorder support and resources

A safety plan for pediatric mental health emergencies

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