Crisis services for suicidal and severely depressed young people may reduce admissions

Design

Systematic review (PRISMA, PROSPERO-registered)

Population

15 studies of crisis interventions for children and adolescents with depression or suicidality

Primary outcome

Symptoms, family functioning and hospitalisation

Effect

Associated with fewer suicidal thoughts, emergency visits and admissions; evidence low certainty

This systematic review, published on 26 October, gathered 15 studies of 15 crisis interventions for children and adolescents with severe depression, suicidal ideation, self-harm or suicidal behaviour.

Four brief, structured interventions aimed at suicidal ideation and self-harm were associated with fewer suicidal thoughts, attempts and emergency visits. Seven family-focused interventions improved communication and family cohesion and were associated with fewer admissions. Three services that stabilised the crisis and linked the young person to community care improved continuity and reduced emergency use. One residential programme gave mixed results.

The common thread is intensive support in the young person's own setting, with the family involved, as an alternative to admission. The authors are clear that the evidence is limited, mostly observational and varied in design, so it cannot show cause. In India, where child and adolescent psychiatric beds are scarce, the elements that seem to work — a structured safety plan, family involvement, and a rapid follow-up link — are achievable in general paediatric practice.

• For a young person in crisis, write a safety plan with them: warning signs, coping steps, people to contact, and how to make the home safer.
• Involve the family in the plan unless doing so would put the young person at risk.
• Arrange follow-up within days, not weeks, after an emergency presentation for self-harm.
• Hand over to a named mental health contact rather than giving a referral letter alone.
• Reserve admission for those whose safety cannot be managed with family and community support.

Why it matters

It suggests that much of what admission achieves may be deliverable at home with family support and quick follow-up.

Don't overread it

The studies were mostly observational and varied; they cannot show that crisis services prevent suicide.

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