Pediatric Mental Health Emergencies in the Emergency Medical Services System

Abstract

Emergency departments are vital in the management of pediatric patients with mental health emergencies. Pediatric mental health emergencies are an increasing part of emergency medical practice because emergency departments have become the safety net for a fragmented mental health infrastructure that is experiencing critical shortages in services in all sectors. Emergency departments must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses, including those with mental retardation, autistic spectrum disorders, and attention-deficit/hyperactivity disorder and those experiencing a behavioral crisis. Emergency departments also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, posttraumatic stress disorder, and maltreatment and those exposed to violence and unexpected deaths. Emergency departments must address not only the physical but also the mental health needs of patients during and after mass-casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support advocacy for increased mental health resources, including improved pediatric mental health tools for the emergency department, increased mental health insurance coverage, and adequate reimbursement at all levels; acknowledgment of the importance of the child’s medical home; and promotion of education and research for mental health emergencies.

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

“…11 Declines in community MH resources for children and adolescents have made PEDs the "safety net" of a fragmented MH infrastructure. 12 Recently published Ontario population data show MH related ED visit rates have increased between 2006-2011 at a higher rate than outpatient visits. 5 In fact, when faced with immediate problems, parents and youth seek emergency medical services prior to contacting their primary care physicians making the PED their first point of contact with the health care system.…”

Substance Abuse and Mental Health Visits Among Adolescents Presenting to US Emergency Departments

“…Among ED reports of mental health visits, studies have focused largely on increased resource utilization, length of stay, and hospital admission. 2,13,14,15,16 Analyses of the overlap of substance use and mental health in the ED have highlighted limitations in assessing, counseling, and outpatient planning. 17,18 However, little research has filled the epidemiologic gap in understanding how substance abuse in adolescents, both as an independent clinical entity and as one component of dual diagnosis states, affects the emergency care system.…”

Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

“…Studies show that more parents are seeking care for their children in hospital EDs to treat acute emergencies [2, 4–6, 10, 11], request guidance for at-home child management [12], and gain access to health care resources [12]. The current health care system, however, does not meet the needs of families in the emergency care setting [3, 4, 13]. Many children do not receive comprehensive treatment for pediatric mental health visits and are discharged without adequate recommendations for follow-up care [14].…”