Community crisis services for suicidal adolescents: promising, not proven

Design

Systematic review, 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 reductions in suicidal ideation, emergency visits and admissions; no pooled estimate

This PROSPERO-registered systematic review found 15 studies of 15 crisis interventions for children and adolescents in acute crisis with severe depression, suicidal ideation or self-harm. Four were brief structured interventions aimed at suicidality, seven were family-focused, three aimed to stabilise and link young people to community services, and one was residential.

The brief interventions were associated with fewer suicidal thoughts, attempts and emergency visits. Family-focused models were associated with better communication and cohesion and lower admission rates, and linkage services with better continuity and fewer emergency contacts. The residential model gave mixed results, with little change in internalising symptoms. The authors are explicit that the studies are heterogeneous and largely observational, so causal conclusions cannot be drawn.

The review supports what many services are already moving towards: keeping a young person in crisis at home with intensive, family-involved support where it is safe. It does not tell you which model works best, and it does not replace admission for a young person at high immediate risk.

• Involve the family early in any crisis plan for an adolescent with suicidal ideation or self-harm.
• Consider intensive home-based crisis support as an alternative to admission when immediate risk allows.
• Arrange a named follow-up contact within days of an emergency presentation, since linkage was the common thread.
• Keep admission available for young people at high immediate risk; the review does not show that home care is equivalent.
• Record emergency visits and admissions if your service pilots a crisis model, so its effect can be judged locally.

Why it matters

Admission is not the only safe response to an adolescent in crisis, and the alternatives deserve a structured place in local pathways.

Don't overread it

Mostly observational and varied studies cannot show that crisis services prevent suicide or are as safe as admission.

The statistics, in plain English

The review did not pool a single effect size, because the interventions and outcomes differed too much to combine. That heterogeneity, and the reliance on observational designs, is why the findings are described as associations rather than proof of benefit.

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