Pediatric Mental Health Concerns in the Emergency Department

Abstract

The top 5 caregivers and youths' main concerns for coming to the ED were similar. However, concordance between perceived concern and clinician assessment is low. Caregivers' expectations for coming to the ED highlight their lack of knowledge of referral procedures and MH services.

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

“…Also, in the present study, approximately 3/4 of patients had no family history of mental illness. Absence of psychiatric hospitalizations and family history of mental illness in the majority of patients and absence of a prior emergency service or outpatient clinic use in approximately half of the patients in the study suggested that the PES could be used by half of the families as a first-line therapy unit, as suggested in some studies (8,12,21). Also, the prior use of one of the mental health services was lower in our sample than in youths admitted to the emergency departments of general or pediatric hospitals, indicating that ED of a mental hospital may be left as the only option for parents, while EDs of other hospitals were seen as a continuum of care.…”

“…In a study of patients between the ages of 8 and 17 years, who presented for mental health concerns to the Crisis Intervention Program located in the ED of a pediatric tertiary care university-affiliated teaching hospital in Ontario, 15% and 15.6% of patients had a past ED visit and prior psychiatric hospitalization for mental health concerns, respectively (8). Another study in the same hospital revealed that most patients did not receive any type of counseling services (psychiatrist, psychologist, or counselor) in the past, and half of the patients had no previous psychiatric diagnosis or history (12). Healy et al (25) reported that of the cases in the mental health emergency service of a psychiatric and a general hospital, 48% were in previous contact with child psychiatry and 21% had previous emergency contact with psychiatric/social services, the latter being associated with older age but not with gender.…”

“…Pediatric EDs have been shown to serve as an entry point into the healthcare system for children and adolescents seeking psychiatric care and are considered a safe area for the lack of inpatient and outpatient mental health services (7,9). Several studies reported a marked increase in the number of children and adolescents seeking care for mental health problems in emergency settings (10)(11)(12)(13)(14)(15). Also, the prevalence of mental health problems in pediatric EDs has been found to be much higher (1).…”

“…Also, the prevalence of mental health problems in pediatric EDs has been found to be much higher (1). Therefore, pediatric EDs have become a primary point of screening and/or evaluation of mental health problems, regardless of whether the problems are considered to be true mental health emergencies (12). Identifying children and adolescents at risk for mental health problems in pediatric EDs and linking them into mental health services can be a crucial and potentially life saving intervention (1).…”

Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from Within

“…Consequently, children and youth may present to the Emergency Department (ED) with psychiatric complaints, in a crisis state or with less acute symptoms. Results of a recent study indicate that most parents/caregivers present to the ED with vague expectations of receiving help and guidance for their child and for themselves (Cloutier et al, 2010). The ED is perceived as a place to receive information and advice, as well as a "gateway" for other MH services (Cloutier et al, 2010;McArthur & Montgomery, 2004;Solomon & Beck, 1989).…”