As the state legislature approves parity between insurance benefits (e.g. hospital stays, medication, etc.) for psychiatric issues and physical illnesses, the word you will not hear is "stabilization."

Stabilization is the dirty little secret of in-patient psychiatric care that is most devastating for juveniles and adolescents. If your troubled child has to be hospitalized because he or she is suicidal — deliberately cutting, burning, or otherwise hurting him or herself — or dangerously aggressive toward others, the word the professional staff uses is "stabilization."

"Your child will undergo stabilization, and then we may want to see her as an outpatient." "As soon as your child is stabilized, we'll be sending him home." "We'll be meeting with your child, evaluating and adjusting medication, and having group therapy during the stabilization period."

Sounds good. And even better if you are a West Sider with a child in the far East Side facility of Laurelwood, stabilization lasts just five days. This is true even with medication change, another field with a rarely spoken term — "half-life."

Example: A teenager suffering from bipolar disorder violently attacks a parent or sibling as well as the police officers who bring him to the hospital. He needs a medication adjustment, but with all medications used for adolescent mental disorders, the only way to determine the exact amount that will work is through experimentation. An increase might be necessary, or might make matters worse (one possible side effect of a mood-altering drug is an increase in the symptoms for which it was prescribed).

So the medicine is changed, and this is where half-life comes into play.

Rarely discussed with patients, half-life is the number of hours that will pass before either half the medication is eliminated from the body, or it begins to take effect. Start a radical reduction of some common anti-psychotic medications on the first day of hospitalization, and the positive or negative results will become visible on the sixth day or later.

For example, two common medications for emotional disturbances with adolescents are Prozac and Zyprexa. Prozac has been the subject of extensive controversy, most recently when a congressional committee began to look into the possibility that testing may not have been so thorough, and its results not as positive, as the public had thought.

Prozac is routinely prescribed for adolescents and adults suffering from depression. It can "jumpstart" someone who has been uncommunicative, listless and barely functioning because of trauma, health problems and other factors. Or it can increase the problem for which it is prescribed. As the manufacturer warns in the literature provided to the medical profession and the public: "In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Prozac or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are starting therapy should be observed closely."

Zyprexa, a relatively new drug for bipolar disorder, is less controversial because the manufacturer has stressed its side effects (obesity, diabetes, etc.) from the start. It can safely be taken with Lithium, long the drug of choice when the condition was still called manic/depressive illness. However, one of the side effects in adolescents can be a radical increase in mania, as well as an exaggeration of other symptoms.

How do you know that Zyprexa and Prozac are working appropriately? You wait and watch, ideally in a controlled setting. To most parents using an adolescent in-patient treatment facility, this means the time of stabilization. They are rarely told that the half-life of each medication is quite different from the maximum allotted for stabilization (third-party payer insurance coverage).

"Stabilization" is five days and out. This means that a child with medication problems may become violent, suicidal, psychotic, or otherwise in serious trouble in a day or more after round-the-clock help has ended.

For example, Prozac takes two to four weeks before the effects are shown. This means that if your child is given the drug on the first day of his hospital stay, then every day after that, continuing when he or she goes home, it will be another one to three weeks before the doctor knows if the decision was right and your child is safe. If the reaction warrants hospitalization to withdraw from the Prozac, the half-life is 7.6 days. The drug will still have some effect on your child for a total of 38 days — more than a month after stabilization.

Zyprexa is better. About a week — two days longer than stabilization — is required to see if it will work. With a half-life of 21 to 54 hours, an adverse reaction will keep your child at risk for up to 10 days.

Why not keep the child hospitalized until the adjustment results are clear? Almost every insurance policy available for children and adolescents, whether an individual program such as Medicaid or a family insurance plan, will only pay for five days of hospitalization per month. Need more? Make certain the kid goes nuts the last five days of the month because then you can piggyback the last five days with the first five days of the next month. Otherwise the hospital has to "eat" the cost of each additional day's stay (unless the parents are wealthy enough to afford approximately $1,000 per day).

The result? Avoidable self-destructive behavior and community violence after release from a stabilization program. The tearful parents, interviewed on the news, say they tried everything but even the best experts couldn't help their child. The medical professionals give sound bites about how our understanding of psychiatric issues is still in its infancy.

And insurance company managers are free to offer each other high-fives because their greed went unnoticed once again.

The state legislature has this one right. Mental health/physical health insurance parity is needed to cover what may be a critical extra day or two in the adolescent unit. Otherwise a child who could lead a productive life may instead become another tragic statistic. As for stabilization, too frequently when used to avoid identifiable real need because the hospital won't or can't cover the cost without assured payment, it should sometimes be seen as a euphemism for results that more rightly should be called involuntary medical manslaughter.