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

“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 Martin, MD, MPH, Editor-in-Chief, Journal of the American Academy of Child and Adolescent Psychiatry

“Congratulations to Drs Prager and Donovan and to the team at MGH for giving us such an important, interesting, and clinically useful book on child psychiatry in the emergency setting. I started reading it and couldn’t put it down.. This is a book that all mental health professionals will find wrenching,meaningful and helpful. Should be required for all medical students, psychiatry residents and child fellows!” —Michelle Riba, M.D.,M.S., Professor and Associate Chair, University of Michigan Department of Psychiatry: Past President, American Psychiatric Association

“The stories in this book are by turns fascinating, puzzling, inspiring, and heartbreaking; they remind us of the limitations on our understanding and on our ability to help, even while they provide a sense of the urgent need for services and centers which can respond to children with psychiatric emergencies, and can support their parents and families.”
—Perri Klass, MD, Professor of Journalism and Pediatrics, New York University

“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 cut of mental illness can be sharper than any surgeon’s knife. Drs. Prager and Donovan go beyond dry, medical patient reports and capture the true stories behind children and families in emotional turmoil.”Dr. Naline Lai and Dr. Julie Kardos, Pediatricians of Two Peds in a Pod

“These true-to-life stories tells us what happens when a child has a psychiatric emergency. These moments of crisis give us a rare glimpse into the child’s emotional problems, the anguish of the families, the challenges faced by the psychiatrists evaluating the situation, and the constraints society imposes in dealing with these very vulnerable families. The authors’ restrained and thoughtful presentation brings the plight of these children into bold relief.”Dr. Mike Jellinek, Chief of Partners HealthCare System, Former President of Newton Wellesley Hospital

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.


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

Every year, almost 700 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.

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

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