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If you determine that the adolescent is not high-risk for suicide or alcohol or substance abuse, she probably doesn't need inpatient services and can be released from the E.D. However, your screenings may indicate that she lacks healthy coping skills and needs a referral for outpatient mental health services. In that case, she should not be released without an emergency plan in place to help her cope with emotional distress. This plan should include crisis line numbers, suggestions for adaptive coping strategies, like talking with friends or family members about her feelings, and additional information about how family members can help should an emergency arise. The plan should be discussed both with the patient and with a parent or guardian.

You'll also want to speak with the patient's guardian about implementing protective strategies. These are strategies that increase the likelihood that patients continue to stay safe after they leave the hospital. Some strategies to discuss with families of at-risk patients include:

• Having a support person – a family member or friend - available to observe a patient and respond to signs of escalating problems or acute risk.
• Scheduling follow-up appointments with mental health professionals, if possible before the patient leaves the E.D.
• Having contact information for agencies that can be called in times of crisis, including the National Suicide Prevention Lifeline [1-800-273-TALK (8255)]. Those answering can indicate what conditions warrant another visit to the E.D.
• Knowing what behaviors to expect while detoxing, and what behaviors should trigger a 911 call.
• Understanding ways to engage in social support, such as joining community-based support groups.
• Feeling connectedness to family and school. This is especially important for adolescents.
• And, being aware of means restrictions.

"Means restrictions" refers to restricting access to means by which someone can carry out a suicidal act. Suicide attempts can be thwarted if individuals have difficulty obtaining means. This includes removing harmful and potentially lethal substances and objects, such as firearms, sharp objects, means of strangulation, and large quantities of prescription and over-the-counter medications. It is especially important to restrict means that the patient has ever thought about using or developed a specific plan to use.