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Get help now.

That was the advice for one caller who contacted the Deseret News/Intermountain Health Care Hospitals Health Hotline on Saturday. The caller's daughter had threatened suicide, and it certainly didn't seem like an idle threat.Many kids may say, off-handedly, that they are going to kill themselves. But then when parents question them, finding out more about what they were thinking, the children usually back off and say they didn't really mean it, or they hadn't thought about it much.

However, this girl was "planning on using a knife," said Marianne Maughan-Pritchett, a therapist at Wasatch Canyons Hospital, 5770 S. 1500 West. The girl's statements indicated she had seriously considered ending her own life. She talked about seeing a knife on a counter and said she would cut her wrist with it.

"They needed to get some immediate (psychiatric) service," Maughan-Pritchett said. She advised the caller to contact a crisis center right away.

Dr. Richard C. Ferre, a psychiatrist who is chairman of the Department of Psychiatry at Primary Children's Medical Center, 100 N. Medical Drive, said many of the callers Saturday had complicated questions.

Nearly 40 Utahns telephoned the hotline seeking information, calling from Orem, Sandy, North Ogden, Centerville, Park City, Clinton, Salt Lake City, Alpine, Layton and other cities.

The number who got through is remarkable, because many had complex and difficult problems. Some answers took 10 minutes or longer. Almost all who reached the hotline ended up on hold.

"There's a large number of people who have adolescents who refuse to get help when they're falling apart," Ferre said, after the two-hour, call-in session ended.

Unfortunately, many parents are unable to advise these kids, he said. The child may be rebellious and angry with the parent.

"The parent becomes the enemy," and communication may be strained.

Maughan-Pritchett said she heard about "a lot of anger and aggression."

According to Ferre, a parent can know the child is having problems if the youngster is changing friends, seems isolated, stays out of school or has dropping grades. A lot of troubled children are using marijuana, he said.

It's hard to get a 17- or 18-year-old into a treatment program. This is especially true if the youth is using drugs, he said.

Many youths get into drug abuse, turn 18, "and they lose 10 years out of their lives," Ferre said.

By that point, a youth may not be committed to treatment against her will. Courts won't allow involuntary commitment to treatment programs unless the patient is a physical threat to himself or others.

"Sometimes I just tell parents that they need to be more relentless than the kids."

The parents need to set limits and not let the kids drift.

Ferre said, "I tell the parents, `Look, if he even comes up close to you and attempts to hit you, that's assault and you can call the police,' " Ferre said. Parents can't afford to let a child intimidate them.

In some cases, police intervention can be the first step toward getting treatment for which the youth will thank a family for the rest of his life.

"At some point, you just insist as a family - even an extended family," Ferre said. "Everybody gets around the kid and says, `You're in trouble. You need help and you're going to get it.' " Then they must make sure he gets treatment.

One woman called about a 4-year-old who seemed to have psychological problems, wanting to know if the child should be put on Ritalin (a drug used to treat hyperactivity and attention deficit disorder). Ferre said that is a matter for a doctor's diagnosis, but that the symptoms the woman cited might indicate a problem that should be treated.

"They (brain disorders) don't respect your age," he said. They can start in the extremely young.

And the sooner a disorder is treated, the better for the child. He cited the case of a 22-year-old who had been depressed throughout childhood. The man had been so withdrawn that he had developed no social skills.

Now on medication, he feels much better. But he is still withdrawn, because he never learned the skills he needed.

"So waiting is really a big mistake," Ferre said.

Maughan-Pritchett said one valuable technique is a written contract between child and parent, with expectations set out along with rewards the child can earn.

As an example of positive reinforcements that could be included in the contract, Maughan-Pritchett told one mother that the child can earn extra time on a computer, or extra TV time. Or if a curfew is respected for a month, perhaps it could become 15 minutes later.

"Both the parent and the child have to work together to write the contract," she said. And the rewards can be social ones, she said.

Those who need to seek help for a child on a non-emergency basis, can telephone the child psychology department at Primary Children's Medical Center at 588-3526; contact them during the normal work week. During an emergency, call the same number and press extension 1 after it answers, or call the hospital's crisis center at 588-3566. Those who wish to contact Wasatch Canyons Hospital can call 262-6199.