Psychotic and psychotic-like symptoms, by themselves, do not necessarily indicate a safety concern. However, the following should prompt a careful safety assessment, and possible call to a mobile crisis team or recommendation that the family bring the child to a Psychiatric Emergency Room:

1. The patient has active or difficult-to-manage suicidal/violent thoughts or impulses.
2. The patient reports current or recent command hallucinations telling them to hurt themselves or someone else. The degree of risk will depend on:
   1. What the commands are
   2. How compelling they are
   3. How specific they are
   4. Whether the patient has acted on them before
   5. The patient’s ability to dismiss or reliably manage them
3. The patient is significantly out of touch with reality for more than several minutes at a time and not actively engaged with mental health provider(s) helping them manage this.
4. The patient’s behavior is severely disorganized or dangerous.

If you have concerns about immediate safety, contact the services listed below.

​For those who experience psychosis symptoms with violent content, helpful initial interventions may include:

• Reinforcing the client for sharing these experiences with you
• Noting they are more common than often believed
• Emphasizing that this is a temporary experience for most people
• Gathering details with existing violence/suicide assessment tools and models
  • Suicidality: SAFE-T, CSSRS, MCPAP Screening Resources
  • Violence: V-RISK 10, Structured Assessment of Violence Risk in Youth (SAVRY)
• Asking follow-up questions to explore the client’s:
  • Emotional reactions
  • Interpretations (particularly beliefs involving the need to act)
  • Details about previous actions in response to these symptoms
  • Coping strategies
  • Access to relevant means
  • Available supports

Boston Emergency Services Team (BEST)

Ages: All
Contact: 1-800-981-4357, available 24/7
Eligible Insurance: Masshealth (any payer), Harvard Pilgrim, uninsured, other select plans— call to determine eligibility
 
Mobile psychiatric crisis evaluation and intervention, including referral to all levels of care. Evaluations available at a variety of community-based locations— i.e., schools, homes, outpatient clinics— as well as onsite at EST Urgent Care Centers. Patients can be screened for a range of presenting issues including possible symptoms of psychosis, other mood/behavioral disturbances, and substance abuse.

Greater Boston Services

MA Statewide Directory