Ten things I know about taking a child to the psych ER

I sat in the Psych ER this afternoon with a Pakistani family whose daughter was being admitted for the first time. It wasn't the girl's first trip to the ER, but she'd never had to stay over before. I said to the father, quietly, "It's hard."

He nodded, and his toothless lower jaw quivered a little. He asked me questions, and I -- the unfortunately seasoned Psych ER mother -- answered as best I could. His daughter, 13, the youngest of many, had cut herself and then flown into a rage when her parents expressed concern. She threw things out the open third-floor window. She pummeled her mother with her fists.

Here is what I told him:

1. Their main goal here is to stabilize your child, not to cure her. They probably won't give a diagnosis unless it's a longer-term stay.
2. Once your child is admitted, bring a notebook and take notes at every meeting with every doctor. Make a record of everything they tell you. You are too emotional to remember facts clearly. Write down the doctor's name, names of medications, names of possible diagnoses. Put dates and times on each set of notes.
3. If you don't feel your child is stable when they want to release her, you can argue about it. If they say they will release her anyway, you write "Parent does not feel child is safe to return home" on the release form, and sign it. 
4. If they release your child and she has to return within the next couple of days, she will probably be placed on a longer-term inpatient stay.
5. If she has to stay longer than the acute care facility allows (usually 3 days), they will need to transfer her to a longer-term facility. You need to find out in advance which ones are the better ones. The question to ask is, "If this were your child, where would you want her to be?" If you don't ask, you get stuck with the first bed that's open, wherever that may be. You can give the social worker in charge of placement a 'short list' of places you'd prefer.
6. If you feel the doctor has fixed ideas and is listening to you only because that's what doctors are supposed to do, it's okay to say, firmly, "I don't think you're hearing the depth of my concerns".
7. If she's dangerous again at home, the rule of thumb is that if you saw someone else doing what she's doing and would call 911, you call 911 for your own child.
8. There are support groups out there for parents in similar situations. Before they release your daughter you will meet with a social worker so there's a plan for followup care. The social worker will know about where to find support groups, though he/she may not volunteer that information. You need to have people to talk to about this without shame.
9. This isn't about your worth as a parent. This is about her problems, which you don't know how to solve. You are here to get help, and you are doing the best you can. 
10. This is hard. This is very hard.