Risks of Judgmental Care

There are few things that are harder for a parent then to admit that they need more help than is available at home or their immediate care team. Finding the strength to not only admit this, but to make the choice of bringing their child to the emergency department (either themselves or through EMS support) should be reinforced with care, unconditional support and relief...this is not always the case.

When parents bring a child to the emergency room during a mental health or behavioral crisis, they are often arriving at one of the most frightening points in the family’s experience. If they are then met with judgment, blame, skepticism, or condescending responses from emergency department staff, the consequences can extend well beyond a single unpleasant interaction. Research on pediatric mental health emergency care identifies stigma, communication failures, mistrust, and lack of family-centered care as significant barriers to effective treatment. (DOI)

These are some of the lasting effects of judgmental care

1. Parents may become less willing to seek emergency care in the future

Perhaps the most significant risk is delayed or avoided help-seeking.

In my experience when parents feel humiliated, blamed, or dismissed they may begin to associate the emergency department with judgment rather than safety.

This can create a dangerous internal calculation:

“If I take my child back, they're going to treat me like I'm a bad parent.”

Stigma is already recognized as a barrier to families seeking mental and behavioral health treatment. When that stigma is reinforced by healthcare professionals, the barrier can become considerably stronger. (DOI)

For a child experiencing suicidal ideation, severe aggression, psychosis, self-injury, elopement risk, or another acute crisis, delaying the next emergency evaluation can have serious consequences.

2. Parents may stop sharing important information

I have seen the direct results of a condescending interaction as potentially causing parents to become guarded.

Parents may hesitate to disclose:

• how severe the behavior actually is;

• previous crises;

• medication concerns;

• aggression or self-injury;

• suicidal statements;

• dangerous behaviors at home;

• what has or has not worked previously;

• developmental or behavioral diagnoses;

• trauma history;

• concerns about the child's safety after discharge.

This is particularly problematic because caregivers often possess critical information about a child's baseline functioning, patterns of escalation, triggers, communication, and previous responses to intervention.

The other risk aspect of this is that when parents begin to withhold information especially on the severity and frequency of behavior; this can put themselves and others at risk.

Research with families presenting to emergency departments has identified communication between parents, youth, and providers as a pivotal component of effective care. Families have specifically described wanting to be heard and included in decision-making. (PubMed Central (PMC))

3. Parents may internalize blame

Condescending comments can unintentionally communicate:

“This is happening because you aren't parenting correctly.”

For families already experiencing exhaustion, fear, grief, and uncertainty, that message can be profoundly damaging.

Parents may begin asking themselves:

• Am I causing this?

• Am I failing my child?

• Should I have handled this differently?

• Does the hospital think I'm a bad parent?

• Will someone think I'm incapable of caring for my child?

Recent research identifies shame, judgment, parental self-blame, and mistrust as psychosocial barriers to behavioral healthcare access. (Springer)

4. Families may become reluctant to disclose future behavioral-health needs

This is especially concerning for children who require repeated emergency intervention.

A family may begin thinking:

“We'll just try to handle it ourselves.”

That can result in families waiting until a situation becomes significantly more dangerous before seeking assistance.

This creates a paradox: the more judgment a family experiences when seeking help, the more likely they may be to avoid seeking help until the crisis becomes unavoidable.

Youth and parents in research have described the ED as an important access point precisely because other mental-health resources can involve substantial wait times, particularly in rural areas. (DOI)