Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service

What Happens to Children with Acute Mental Illness

by Laura M. Prager, MD and Abigail L. Donovan, MD


Every year, almost 850 children come to the psychiatric emergency room at Massachusetts General Hospital. Sometimes these children have acute psychiatric problems. Sometimes the family is in crisis. Many find this emergency room both their entrance into mental health treatment and their last stop before incarceration or foster care.

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Cover image for Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service

July 2012


Pages 115
Volumes 1
Size 6 1/8x9 1/4
Topics Psychology/Child and Teen

This book offers a unique glimpse into the startlingly complex world of acute children's psychiatry through 12 chapters, each inspired by the actual visit of a child in psychiatric crisis to one of the most well-known psychiatric emergency rooms in the nation.

Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service: What Happens to Children with Acute Mental Illness takes the reader inside the child psychiatry emergency room at Massachusetts General Hospital (MGH) in Boston. Each chapter highlights both the child's dilemma and the doctors' thought processes, and stresses the elements of rapid assessment. The real-life patient stories also offer myriad teaching points about child development and the warning signs of illness, and provide compelling lessons regarding types of interactions with school systems, health care systems, and family systems. Each individual story presents the breadth and depth of the child psychiatric emergency evaluation at MGH, from initial assessment to disposition, presenting a genuine glimpse into the children's psychiatric emergency room at one of the nation's most famous psychiatric departments. This book demonstrates vividly how even the best-intentioned communities can fail to offer services to their neediest families. Each story presents a fascinating glimpse into the complex and sometimes tragic world of child psychiatry on the front lines.


  • Provides a unique and unprecedented discussion of emergency psychiatric care for children in crisis
  • Offers unique perspectives on specific aspects of emergency child psychiatry, including child development, emerging mental illness, family conflict, and systems of care
  • Presents an actual story of a child in crisis within each chapter, supplying educational content that is grounded in real life and highly accessible to a wide range of readers
  • Supplies insights from psychiatrists with decades of combined experience treating children on the front lines
Author Info

Laura M. Prager, MD, is assistant professor of psychiatry (child psychiatry) at Harvard Medical School and director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. She is assistant editor for the Journal of the American Academy of Child and Adolescent Psychiatry, and a reviewer for the journals Pediatrics, Critical Care Medicine, and Psychiatric Services and Psychosomatics. Prager has authored or coauthored articles in The Harvard Review of Psychiatry, Psychiatric Times, Journal of the American Academy of Child and Adolescent Psychiatry, and others, as well as chapters in books published by Mosby, Elsevier, and the American Academy of Pediatrics. She has won numerous teaching awards from the Department of Child Psychiatry at the Massachusetts General Hospital.

Abigail L. Donovan, MD, is assistant psychiatrist at Massachusetts General Hospital and clinical instructor of psychiatry at Harvard Medical School. She is associate director of the Acute Psychiatry Service at Massachusetts General Hospital. Donovan has authored or coauthored articles in Proceedings of the National Academy of Sciences and Pediatrics and the Journal of Clinical Psychiatry as well as book chapters.



"These tales are riveting. In the book’s introduction, Praeger acknowledges a fascination with the children’s stories. Clearly she understands how to listen carefully and, more important here, portray a character in a few well-chosen phrases. Readers hear, see and smell the tiny interview rooms where psychiatry residents speak to their patients. . . . insightful and disturbing. . . . Putting a human face on a problem can help people comprehend it, and ideally motivate them to act. Suicide by Security Blanket presents a particularly disturbing set of faces with an especially powerful claim to attention. May it yield the kind of action its subjects so urgently require."—The Washington Independent Review of Books


Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service is a rare and candid look at the state of child psychiatry today. In twelve unflinchingly told vignettes, Laura Prager and Abigail Donovan, two child psychiatrists from Massachusetts General Hospital, limn the fine balance between the pathologic and the merely unusual, the dangerous and the just wild ... The book alternates between scene and narration, showing us clinical scenarios in painful detail, then sharing with us the doctors’ thought processes and decision-making strategies ... A compelling read and should be required reading for any child psychiatry residency program.”—Carolyn Roy-Bornstein, Pediatrician and Author of Crash: A Mother, a Son, and the Journey from Grief to Gratitude

"This unusual, refreshing, and valuable book presents the stories of individual children in the psychiatric emergency room, with a clarity and depth of detail rarely accessible to an audience of general readers. Each case is presented from multiple viewpoints: the child, the family, and the responding professional team. Engrossing as these narratives are as specific cases, they also speak eloquently to the overall failures in social responsibility which help propel families and children into crisis. The vignettes beautifully reflect the complexity and sometimes ambiguity of real-life emergency room child psychiatry while remaining coherent and comprehensible to the layperson. At the same time, the inadequacy of our system of mental health services for children and adolescents is painfully apparent. This volume is a clearly-expressed, sensible, and persuasive addition to public dialogue on mental health care as it meets (at its best) and does not meet (as is typical) urgent psychiatric needs of children and families."

—Elizabeth Berger, MD, Child Psychiatrist and author of Raising Kids with Character

"The growing awareness of childhood mental illness has uncomfortably collided with fewer community resources through which to provide effective care. Overburdened emergency rooms across the nation have often become the one available clinical haven for children and their families at times of need. In Suicide by Security Blanket, Prager and Donovan capture with palpable empathy and concern the realities of these seldom-seen regions. Their book alerts us to a rising pediatric tide we ignore at our own peril."

—Andrés S. Martin, MD, MPH, Yale Medical Group

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