Pediatric and Adolescent Mental Health Emergencies in the Emergency Medical Services System

Abstract

Emergency department (ED) health care professionals often care for patients with previously diagnosed psychiatric illnesses who are ill, injured, or having a behavioral crisis. In addition, ED personnel encounter children with psychiatric illnesses who may not present to the ED with overt mental health symptoms. Staff education and training regarding identification and management of pediatric mental health illness can help EDs overcome the perceived limitations of the setting that influence timely and comprehensive evaluation. In addition, ED physicians can inform and advocate for policy changes at local, state, and national levels that are needed to ensure comprehensive care of children with mental health illnesses. This report addresses the roles that the ED and ED health care professionals play in emergency mental health care of children and adolescents in the United States, which includes the stabilization and management of patients in mental health crisis, the discovery of mental illnesses and suicidal ideation in ED patients, and approaches to advocating for improved recognition and treatment of mental illnesses in children. The report also addresses special issues related to mental illness in the ED, such as minority populations, children with special health care needs, and children's mental health during and after disasters and trauma.

Identifying suicidal behavior among adolescents using administrative claims data

“…Clinicians face challenges in determining whether an injury to a child or adolescent is self-inflicted, and if so, whether the injury was accompanied by intent to die. 2,11 Characteristics of administrative claims codes also present challenges to identifying suicidal behavior. 6 For example, an E-code for suicide & self-inflicted injury can be correctly utilized for any self-inflicted injury.…”

Mental Health Utilization in a Pediatric Emergency Department

“…It has been estimated that 6 to 9 million children have serious emotional disturbances 1 . Studies show that over half a million children a year present to an emergency department (ED) with a mental health problem and of the children successfully committing suicide, over half of them had been seen by a physician in the 1 to 6 month prior to their death 2-3 . Policy statements and technical reports have been issued by organizations endorsing the need for ED's to serve as a safety net for this large population.…”

Bullying and Suicide Risk Among Pediatric Emergency Department Patients

“…The AAP and Joint Commission (JC) both recommend screening all ED patients for suicide risk. 20-21 Understanding psychosocial correlates of suicide risk, such as bullying victimization, may help guide ED-based interventions and referrals. However, there have been no studies examining bullying victimization and risk of suicide in youth who present to pediatric EDs.…”