Learn: what we wish we had known
Plain-language information about warning signs, common conditions, ER visits, holds, placement, school and medications, from parents who have been there.
The signs aren't always obvious
Not every struggling child talks openly about suicide or asks for help. Sometimes the warning signs look different.
Sometimes there are very few signs
Some kids mask incredibly well. They go to school, play sports, hang out with friends and tell everyone they're okay while struggling inside.
If you're carrying guilt: you are not alone, you did not cause this, and you are not to blame.
This isn't about blaming parents
Loving parents can still have children who struggle deeply. Supportive homes can still go through mental health crises. It's about awareness, early conversations, emotional safety, and support before a crisis whenever possible.
What kids need most
- Connection
- Listening without immediately fixing
- Emotional safety
- Coping skills
- Love and patience
Sometimes they just need someone who will sit beside them in the hard moments.
Mental health struggles don't always announce themselves loudly. Sometimes they whisper long before they scream.
Understanding common conditions in youth
These are real, serious and treatable. Healing is possible. Tap a condition to learn what it can look like. Only a qualified professional can diagnose.
DepressionMore than just feeling sad
- Persistent sadness or emptiness
- Loss of energy or motivation
- Pulling away from friends or activities
- Changes in sleep or appetite
- Trouble concentrating
- Feeling hopeless or worthless
AnxietyMore than normal worry
- Excessive worry or overthinking
- Physical symptoms like stomachaches or headaches
- Avoiding school, people or situations
- Restlessness or feeling "on edge"
- Panic or fear of many things
- Needing constant reassurance
ADHDMore than distracted — it's how their brain works
- Difficulty focusing
- Impulsivity
- Restlessness or hyperactivity
- Emotional outbursts
- Trouble finishing tasks
- Forgetfulness, trouble with organization and time
- Rejection sensitivity
AutismA different way of experiencing the world
- Sensory sensitivities
- Differences in social communication
- Need for routine and predictability
- Intense interests or hyperfocus
- Emotional overwhelm or shutdowns
- Repetitive behaviors or stimming
- Anxiety around change or transitions
Different, not less. Youth with ADHD or autism can also face a higher risk of anxiety and depression, so watch for both.
Trauma & PTSDIt's not their fault. It's not their choice.
- Anger or aggression
- Emotional shutdown or numbness
- Anxiety, panic or constant worry
- School refusal or academic struggles
- Hypervigilance, always on guard
- Control issues or perfectionism
- "Defiance" or frequent trouble
- Flashbacks or nightmares
- Avoiding people, places or reminders
- Easily startled or panic attacks
- Feeling unsafe even in safe places
- Difficulty regulating emotions
- Dissociation or numbness
Behavior is communication, not defiance. Children don't need to be "fixed." They need safe, supportive relationships.
OCDIntrusive thoughts + compulsions
Unwanted, distressing thoughts, followed by rituals done to reduce anxiety or "prevent something bad."
- Repetitive checking
- Needing reassurance
- Fear of contamination
- Counting or repeating
- Intrusive, scary thoughts
- Panic when routines change
- Perfectionism and guilt
Eating disordersNot about food — about much more
Often tied to anxiety, control, body image, emotional pain, perfectionism and fear.
- Restricting food
- Binge eating
- Purging
- Overexercising
- Body checking
- Hiding behaviors
They are not seeking attention — they are seeking relief. The National Alliance for Eating Disorders offers a free helpline and support for families.
Mood disordersMore than normal mood swings or teenage emotions
Can include major depression, bipolar disorders (see below), DMDD, persistent depressive disorder and PMDD.
- Severe highs and lows
- Rage or irritability
- Impulsive or risky behavior
- Hopelessness or numbness
- Changes in sleep or energy
- Self-harm or suicidal thoughts
Bipolar IFull manic episodes
Defined by at least one manic episode: an abnormally elevated, expansive or irritable mood with high energy, lasting at least a week, or severe enough to need hospitalization. Most people also have depressive episodes.
- Little need for sleep without feeling tired
- Racing thoughts, very fast speech
- Grandiose ideas or feeling invincible
- Risky or impulsive choices (spending, driving, sex, substances)
- Sometimes psychosis (losing touch with reality)
Mania can be a medical emergency. Call the provider, 988, or go to the ER if your child is unsafe or out of touch with reality.
Bipolar IIHypomania + major depression
Involves at least one hypomanic episode (a milder, shorter "up" period lasting at least 4 days) and at least one major depressive episode, but never full mania.
- Hypomania can look like a burst of productivity, confidence or irritability, and is easy to miss
- Depression is often the longest and hardest part
- Frequently mistaken for depression alone. Tell providers about any "up" periods.
Bipolar II is not "milder bipolar." The depressive episodes can be severe and carry real suicide risk.
CyclothymiaThe "lesser" form of bipolar
Cyclothymic disorder involves frequent ups and downs (hypomanic and depressive symptoms) that don't reach the level of a full episode. In children and teens, symptoms are present for at least a year, with no more than two months symptom-free.
- Moods that shift often, from upbeat and energetic to low and irritable
- Can seem like "just moodiness," but it is persistent and disrupts daily life
- Some youth with cyclothymia later develop bipolar I or II, so follow-up matters
Emotional dysregulationIntense emotions that are often misunderstood
- Intense emotional reactions
- Fear of people leaving
- Impulsive behaviors or self-harm
- Unstable relationships
- Black-and-white thinking
- Chronic emptiness, rapid mood shifts
Underneath is often deep emotional pain, not manipulation or attention-seeking.
PsychosisA loss of connection with reality
- Hallucinations
- Paranoia
- Delusions
- Confusion or disorganized thinking
- Difficulty knowing what is real
Many children experiencing psychosis are terrified and confused, not dangerous. Early treatment matters. Contact a provider promptly.
Listen. Believe. Support. Be safe. You can make a difference.
Passive and active thoughts both deserve help
Passive
A wish not to be here, without a plan. Your child might say things like:
- "I wish I wouldn't wake up."
- "I don't want to exist anymore."
- "I just want everything to stop."
Active
Thoughts that include any of these:
- Intent to act
- A plan
- Preparation
- Access to a way to do it
What you can do
- Take it seriously, even when it sounds passive or "just venting."
- Ask directly and calmly whether they are thinking about suicide. Asking does not put the idea in their head.
- Call or text 988, any time, to talk through what to do next, including as a parent.
- If there is a plan, intent, an attempt, or you can't keep them safe, call 911 or go to the ER, and don't leave them alone.
- Tell their therapist or doctor, and make a safety plan together.
You are not alone. We are here. There is hope.
When substances are part of the picture
Substance use and mental health struggles often go hand in hand. Many teens use substances to quiet anxiety, depression or trauma, and substances can make those conditions worse. Treating both at the same time (called co-occurring or dual diagnosis care) works best.
Signs to watch for
- New friends, secrecy, lying or missing money
- Changes in sleep, appetite or hygiene
- Red eyes, slurred speech, unusual smells
- Falling grades, skipping school, dropping activities
- Vapes, pills, baggies, foil or other paraphernalia
- Mood swings, irritability, paranoia
What helps
- Stay calm and curious. Lead with concern, not punishment.
- Ask their doctor or therapist for a substance use screening.
- Look for programs that treat mental health and substance use together.
- Lock up medications and alcohol at home.
- Keep naloxone (Narcan) on hand. It reverses opioid overdoses and is sold over the counter.
Where to start
- SAMHSA National Helpline: 1-800-662-4357, free, confidential, 24/7 treatment referrals
- Charlie Health: virtual IOP for mental health and substance use, available across Wyoming
- Volunteers of America Northern Rockies: (307) 634-9653, substance use and mental health services in Cheyenne
- Wyoming 2-1-1: dial 2-1-1 for local options
Overdose is an emergency
If your child is unresponsive, breathing slowly or not at all, or has blue lips: call 911, give naloxone if you have it, and stay with them.
A safer home creates a safer tomorrow
Making your home safer during a mental health crisis isn't about punishment. It's about prevention. It's not forever; it's for right now.
Medications
Lock up prescription and over-the-counter medications, including everyone's in the household.
Firearms
No access during periods of higher risk. Use locked storage, or temporary storage away from home when possible.
Sharps & other items
Secure items based on your child's history and what is a risk for them.
Alcohol & substances
Limit access. Being intoxicated can increase risk.
Vehicles
Consider managing access to car keys, depending on the situation.
Supervision
Sometimes they shouldn't be left alone. Have a plan for who can be with them.
Think beyond your house
Consider other homes, school, work, backpacks, vehicles and anywhere else they spend time.
Adjust as needed
Safety measures can change as risk changes. Work with their treatment team and revisit the plan.
What to expect
The ER is for safety, stabilization and assessment. It is not ongoing treatment.
- Reason for visitA crisis, suicidal thoughts, self-harm, an attempt, or concerns raised by a school or provider.
- Medical clearanceAn ER doctor checks that your child is medically stable.
- Behavioral health unitOnce medically cleared, your child may move to a separate, locked area for safety.
- Safety precautionsScrubs, safety socks, continuous observation and regular documented checks.
- Psych evaluationA psychiatric provider evaluates your child and recommends next steps.
- OutcomeDischarge home with a safety plan, or a recommendation for inpatient care.
- Waiting for placementIf inpatient care is needed, your child may stay in the ER until a bed opens. That can take hours or even days, with monitoring and safety but no ongoing therapy.
Parent rights: you have a voice
- You can ask questions about what's happening and what comes next.
- You can ask for clarification on any recommendation.
- You can advocate for preferred facilities if placement is needed.
- You are part of discharge planning.
- If a hold is involuntary, your ability to take your child home may be limited for safety reasons. The hospital must follow state law.
Mental health "holds"
Different names, same reality. Some states call it an M-1 hold; others call it emergency detention or involuntary hospitalization. In Wyoming, these fall under Title 25 of state law.
What it is
A legal hold used when a child is considered a danger to themselves or others. It lets providers keep them for evaluation, even if you want to leave.
Voluntary: you agree to keep your child in the hospital for evaluation and safety. Involuntary: a provider determines your child can't safely leave.
Holds can…
- Be placed in the ER, or during inpatient care if things escalate
- Last up to about 72 hours for evaluation (varies by state and situation)
- Lead to a transfer to another facility, sometimes far from home
- Happen even if you came in voluntarily
Please remember
- It can happen more than once.
- That doesn't mean you're failing.
- It doesn't mean your child is "worse."
- It means safety is being prioritized in a system most of us aren't prepared to navigate.
"I remember how confusing it felt. How fast everything moved. How little I understood in the moment. And how alone it felt." — Alyssa
Placement facts & your rights in the ER
You have a voice in placement
You can strongly advocate for specific facilities, especially if you've had prior experiences, good or bad. For us, most placements were in Colorado, and we learned quickly which places were and weren't a good fit for our child.
Speak up. Your experience matters.
Packets can go to multiple facilities
Your child's referral packet can be sent to several facilities at once. If you have a top two or three, ask for that. You can advocate for where your child would do best.
If it matters to you, say it clearly.
Placement depends on several factors
- Bed availability, often the biggest factor
- Level of care (acuity)
- Insurance and network limits
- Facilities often work from first available bed, so availability can outweigh preference
Transportation & paperwork matter
In most cases you'll sign consent for transport (unless there's a hold). Don't feel pressured to sign too early. Transfer times shift, facilities change and plans update fast.
"I almost missed my child being transported because the transfer time changed, I wasn't notified, and they were ready to move forward because paperwork had already been signed. That's a moment I will never forget."
Advocate. Ask questions. Take a breath before signing anything. And stay as involved as you can in every step.
Ready to compare programs? See questions to ask before placement and levels of care.
Schooling looks different at every level of care
Inpatient
The focus is safety and stabilization. Schooling is very limited, maybe packets or short periods, and often not coordinated with the home school.
PHP / IOP
Often about 1–2 hours of school time a day, working on assignments from the home school while balancing therapy and treatment.
Residential
Usually several hours of school daily with grade-level teachers, the most structured education alongside therapy.
Students may be eligible for
- 504 accommodations
- IEP / IDEA services
- Attendance flexibility
- Adjusted workloads or schedules
- Reintegration and transition planning
Need help? The Wyoming Parent Information Center supports families with IEPs and 504s.
Parents have the right to
- Request evaluations for accommodations
- Take part in educational planning meetings
- Advocate for academic support during treatment
- Talk directly with school counselors and administration
Mental health treatment does not mean a child has failed academically. Healing and safety come first.
"Early on, we struggled significantly with flexibility during hospitalization. Later, our high school team was incredible with accommodations, treatment coordination, and helping support the transition back to school."
Questions to ask your provider about medications
You deserve clear answers and a plan you feel confident in. Tick these off as you go; your progress stays on this device.
1How it should help
2Side effects & safety
3Day to day
4When to reach out
By the numbers
National figures from the CDC's Youth Risk Behavior Survey of U.S. high school students (2023), then Wyoming.
Some good news: the CDC's 2025 survey showed improvement, with about 1 in 3 students reporting persistent sadness or hopelessness. Source: CDC YRBS.
Wyoming figures: America's Health Rankings; Laramie County Coroner. Read more about the gap in Wyoming →
Early support can save lives. You are not alone.