Psychiatric emergencies in children

Emergency mental health care for youth in Washington State: qualitative research addressing hospital emergency departments' identification and referral of youth facing mental health issues

OBJECTIVES

The purpose of this formative research was to gain a better understanding of how Washington State hospital emergency departments (EDs) identify and refer children and adolescents with mental health concerns. Increased understanding of emergency mental healthcare for youth will lead to the development and implementation of strategies and policies that enhance the system of providing mental health services to children and adolescents.

METHODS

We conducted structured group interviews, a form of qualitative research, with ED, social work, and mental health administrators and providers in 9 hospitals in Washington State.

RESULTS

Interviews reflected a systemwide lack of emergency mental health services for youth, as well as a lack of coordination between the larger mental health system and hospital ED. In addition, we identified issues specific to the hospital/ED such as insufficient availability of social work and mental health staff, lack of mental and behavioral health screening tools, lack of knowledge of available mental health services, and lack of clarity about the ED's role in identification of mental health concerns.

CONCLUSIONS

Specific interventions should be developed, implemented, and evaluated to increase coordination between the ED and the larger mental health system. This should include methods for increasing ED staff knowledge of available and accessible mental health services for youth, perhaps through an online system. In addition, the role of the ED in identifying youth facing mental health issues should be clarified, and a brief, nonintrusive screening tool for identifying emergency mental health concerns should be developed.

Child and adolescent psychiatric emergencies: family psychodynamic issues

Given the impact of the family on the etiology, identification, and treatment of child mental health problems, this article addresses the role of the family in psychiatric emergencies. This article covers relevant aspects of family evaluation in an emergency context, factors that determine the family's role in disposition, and planning of family considerations in several specific clinical emergencies. Improved understanding of the family's contribution leads to a more accurate diagnostic consideration and more appropriate disposition recommendations. A correct diagnosis and appropriate discharge plan lead to an improved prognosis for overall follow-up care and treatment.