Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • AAP Policy
    • Topic/Program Collections
    • Policy
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effect on Pediatric Health
    • More Collections...
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Alerts
    • Table of Contents
    • Insights
  • AAP Career Center
  • Subscribe
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • AAP Policy
    • Topic/Program Collections
    • Policy
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effect on Pediatric Health
    • More Collections...
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Alerts
    • Table of Contents
    • Insights
  • AAP Career Center
  • Subscribe
FOCUS ON SUBSPECIALTIES

Flood of pediatric mental health patients strains emergency department resources

Steven C. Rogers and Thomas H. Chun
AAP News June 2014, 35 (6) 1; DOI: https://doi.org/10.1542/aapnews.2014356-1a
Steven C. Rogers
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thomas H. Chun
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Comments
Loading
Download PDF
  • Copyright © 2014 by the American Academy of Pediatrics


Embedded Image

Over the last decade, there has been a concerning rise in emergency department (ED) visits for mental health concerns. Pediatric patients are being referred to the ED by mental health providers, schools and pediatricians, and many are brought by family members.

Between the late 1990s and last year, such visits to the Connecticut Children’s Medical Center ED skyrocketed from 400 to 2,500 annual visits. This increase mirrors national trends and has resulted in more than 500,000 annual visits to EDs for pediatric psychiatric problems (Pittsenbarger ZE, Mannix R. Acad Emerg Med. 2014;21:25-30).

Many EDs already are straining to deal with issues involving capacity and limited resources while still providing high-quality care for all patients. This burgeoning mental health crisis has significant implications for all those involved, including mental health patients, other patients and ED care providers.

For patients seeking emergent mental health care, there may be long waits for risk evaluation and even longer boarding in the ED for those requiring inpatient services. To ensure the safety of these potentially high-risk patients, they often are triaged at the highest acuity level and given priority for evaluation rooms. At times, mental health patients can outnumber typical ED patients. As a result, patients seeking emergent medical care may face prolonged wait times, increasing rates of leaving without being seen.

Figure1

Dr. Rogers

Finally, health professionals who care for high-risk mental health patients face increased levels of stress. Providers and staff struggle with more difficult triage decisions, increased staffing demands to provide direct observation of patients, and insufficient psychiatric training to handle the prolonged care of mental health patients in crisis.

Figure2

Dr. Chun

Responding to this crisis

An estimated 70% of patients cared for in EDs will screen positive for at least one mental health disorder. Most individuals who commit suicide have seen a health care professional within a few months of killing themselves. Every ED visit may be an opportunity to screen and identify high-risk patients and to intervene early, which ultimately may prevent future ED visits.

Following are recommendations on how EDs can balance the needs of mental health patients with those of other patients and staff:

  • Ensure the ED has appropriate support and levels of care.

    • EDs should have well-defined processes and services to ensure adequate mental health care.

    • Utilize all available resources, including social work and administrative support.

    • Develop plans to ensure the safety and efficient risk assessment with disposition planning.

    • Identify partnerships with local and state agencies to provide appropriate outpatient care.

  • Improve screening/care models to identify and provide appropriate resources before they require emergency care.

  • Dedicate more time in pediatric residency and fellowship curriculums to ensure adequate understanding of mental health risk assessment and appropriate care provision for mental health patients.

  • Advocate at the local, state and national levels with a focus on the actions recommended in the 2006 AAP policy statement, Pediatric Mental Health Emergencies in the Emergency Medical Services System, http://pediatrics.aappublications.org/content/118/4/1764.full.pdf.

Resources for ED professionals

Following are some resources to help health care professionals working in EDs manage pediatric patients with mental health concerns:

  • The 2011 AAP technical report Pediatric and Adolescent Mental Health Emergencies in the Emergency Medical Services System, developed by the Committee on Pediatric Emergency Medicine, describes the role of the ED provider in mental health care for U.S. children and adolescents, http://pediatrics.aappublications.org/content/127/5/e1356.full. The committee is developing a new AAP clinical report regarding pediatric mental health emergencies.

  • The American Academy of Child and Adolescent Psychiatry website provides resources as well as a way to identify local child and adolescent psychiatrists, www.aacap.org/AACAP/Families_and_Youth/Resources/CAP_Finder.aspx.

  • The Suicide Prevention Research Center (www.sprc.org) and the National Suicide Prevention Lifeline (www.suicidepreventionlifeline.org) provide resources on suicide prevention, including a registry of evidence-based practices.

  • The Substance Abuse and Mental Health Services Administration provides a regional treatment locator, www.findtreatment.samhsa.gov/MHTreatmentLocator.

  • Massachusetts Child Psychiatry Access Project (http://www.mcpap.com/) describes a successful model for mental health patients in schools and primary care settings, which may increase utilization of community resources and ultimately reduce ED visits.

  • Resources for gay, lesbian, bisexual and transgender youth:

    • The Trevor Project (www.thetrevorproject.org) provides suicide prevention and crisis intervention.

    • GLBT National Youth Talkline (www.glnh.org/talkline) provides telephone and email peer-counseling, as well as factual information and local resources.

Footnotes

  • Dr. Rogers is chair of the AAP Section on Emergency Medicine Committee for the Future. Dr. Chun is a member of the AAP Committee on Pediatric Emergency Medicine.

PreviousNext
Back to top

Advertising Disclaimer »

In this issue

AAP News: 35 (6)
AAP News
Vol. 35, Issue 6
1 Jun 2014
  • Table of Contents
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Flood of pediatric mental health patients strains emergency department resources
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Flood of pediatric mental health patients strains emergency department resources
Steven C. Rogers, Thomas H. Chun
AAP News Jun 2014, 35 (6) 1; DOI: 10.1542/aapnews.2014356-1a

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Flood of pediatric mental health patients strains emergency department resources
Steven C. Rogers, Thomas H. Chun
AAP News Jun 2014, 35 (6) 1; DOI: 10.1542/aapnews.2014356-1a
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
  • Table of Contents

Jump to section

  • Article
    • Responding to this crisis
    • Resources for ED professionals
    • Footnotes
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Infants with hypoxic-ischemic encephalopathy may need to be transported for therapeutic cooling
  • Rare genetic autoinflammatory conditions may provide clues for juvenile dermatomyositis
  • Asthma attacks caused by common colds continue to vex medical community
Show more FOCUS ON SUBSPECIALTIES

Similar Articles

Subjects

  • Emergency Medicine
    • Emergency Medicine
  • AAP NEWS BY DEPARTMENTS
    • Focus on Subspecialties
  • Terms of Use
  • Privacy Statement
  • FAQ
  • Contact Us
  • 2021 AAP Journals Catalog
  • Pediatrics
  • Pediatrics in Review
  • Hospital Pediatrics
  • NeoReviews
  • AAP Grand Rounds
  • AAP Career Center
  • shopAAP
  • AAP.org
  • AAP News
  • Visit AAP News on Facebook
  • Follow AAP News on Twitter
American Academy of Pediatrics

© 2021 American Academy of Pediatrics