When to take a threat seriously

LeeAnn, 14 would get into angry shouting matches with her mother.  She’d scream, “You don’t understand! You don’t care!  I’m going to kill myself!”  Tony J. was a good kid, but he was often picked on, coming home from school, in the halls, the locker room and now was being harrassed on Facebook, by kids who didn’t even know him.  “I oughtta blow them all away!” he said to his only friend, who was scared at Tony’s intensity.  Roshelle threatened to run away, when discipline for violating curfew was enforced, and Juan scared his single mom when he shoved her roughly and told her she’d ‘pay for it’, for making him stay with his dad over the summer, out of state. When are children’s threats serious?

The American Academy of Child and Adolescent Psychiatry issues a series of bulletins called, ‘Facts for Families’- see http://www.aacap.org Pamphlet No. 65 lists examples of potentially dangerous or emergency situations with a child or adolescent. Dr. Sathappan, Psychiatrist and Medical Director for Pomegranate Health Systems says, “If a teen makes threats to harm themselves or someone else, or exhibits threatening behaviors which include violence towards family members, friends, pets or property or talks about running away or acting out other threats, it should be taken seriously. If a child has assaulted others in the past, had anger management problems, or exhibited violent behavior, that should also be taken seriously because it can be another warning sign.”

The teen years can be moody,  but there are some additional risk factors for violent or dangerous behavior that must be taken into account: 1) activities/behavior, 2) environmental and 3) potential lethality/suicidal risk.

Activities/Behavior: • Exhibiting menacing or threatening behavior, angry outbursts, or assaulting others • Writing, reading, selecting violent stories, video games, movies, art, music, clothing or similar themes • Pre-occupation with death or expressing thoughts or feelings of depression and hopelessness • Hanging out with negative peers, a ‘bad crowd’, gang or instigator • Drug or alcohol abuse –either self, family or both • Being bullied or bullying others • Making threats or intimidating parents, siblings, relatives or peers • Destructive behavior of personal property, arson or vandalism • Cruel to pets and animals. Environment:  • A teen’s family, self or peers have a history of mental illness- mania, psychosis, bipolar disorder, schizophrenia • There is little or no parental or social support or supervision; teen is a loner • Either witnesses or is the victim of a violent act • Experienced domestic violence- whether sexual, physical or emotional • Ready access to weapons or attempt to bring weapons or other means of violence into school or community setting • Disciplinary problems in school and/or community. Lethality/Suicidal risk: • Making or attempting suicidal or homicidal threats • Family member attempted or completed suicide • Accessibility of weapons, drugs, alcohol and/or other means of violence • Have a plan and/or means to complete violence.

The experts advise that a child or adolescent receive an immediate evaluation and remain under supervision while waiting for professional care. If the situation escalates or a teen and his/her family refuses help, experts advise to contact police so the adolescent might be taken to an emergency room to avert tragedy and receive the necessary assistance. “Often, defiant and angry behavior masks a wall of pain, which is just breaking through, coming out in explosive bursts. We address that here,” adds Demetra Taylor, Clinical Director at Pomegranate Health Systems.

The Youth Risk Behavior Survey, a school survey conducted by the ODMH/ODADAS and ODH, with ODE in collaboration evaluated 539,142 Ohio high school students. Their report shows that “6.2% of an estimated 35,900 adolescents reported that they did not go to school because they thought they would be unsafe at school or on their way to school. In the same survey 9.1% of an estimated 45,800 Ohio adolescents reported one or more suicide attempts in the past year.” Additionally, the Children’s Mental Health Fact Sheet reports that “27.1% of an estimated 155,600 Ohio adolescents felt sad and hopeless almost every day for two weeks and 22.7% of or an estimated 130,000 Ohio adolescents had been bullied on school property in the last 12 months.”  That’s a lot of misery and fear.

Relationship violence plays a role, “13.9% . . . reported being in a relationship or an estimated 60,400 Ohio adolescents said their boyfriend/girlfriend hit, slap(ed), or physically hurt them on purpose during the past 12 months.” The problem identified by the YRBS statistics show that “two thirds of adolescents affected by mental health issues do not seek services.”  There are some resources which can help. Resiliency Ohio http://www.resiliencyohio.org/  has youth and family videos, articles and insights on resiliency, suicide prevention, principles of care, risk and protective factors and other training tools. Healing is possible, and there is hope-as SAMHSA says. “Its important to pay attention to verbal and non-verbal cues alike, and to take each threat seriously,” adds Taylor.

[Photo credit: Yelling Gun Man by Jason Stitt/ Dreamstime.com 8742590]

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About Communications

Communications and Social Media @ Sequel-Pomegranate Health Systems
This entry was posted in acute hospital, adolescent psychiatry, behavioral health, behavioral health disorders, mental health, pediatric psychiatry, psychiatric care, residential treatment and tagged , , , , , , , , , . Bookmark the permalink.

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