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Abstract
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Despite being preventable, suicide remains the second-leading cause of death for children and adolescents in the US.1 Up to 80% of children and adolescents who die by suicide interfaced with the health care system in the year prior to their death,2 indicating an opportunity for improved risk recognition and intervention. In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in child and adolescent mental health, because existing severe mental health challenges among children and adolescents worsened during the COVID-19 pandemic. Pediatric mental health clinicians and treatment facilities are critically overburdened, delaying access and resulting in increased emergency department (ED) use for mental health concerns.
Pediatric emergency medicine clinicians have witnessed the worsening public health epidemic of mental illness in children and adolescents. Over the past decade, pediatric ED visits for mental health have disproportionately increased relative to non-mental health emergencies.3 ED clinicians frequently manage previously unrecognized mental health disorders, self-harm behaviors, nonfatal ingestions, and suicide attempts among children and adolescents. Suturing self-inflicted lacerations, providing chemical restraint for acute agitation, and engaging these patients with suicidal ideations in safety planning have become common practice in the ED. However, despite an increasing referral base from health care clinics, mental health crisis centers, schools, and community-based services, ED clinicians and staff lack formal training in the management of mental and behavioral health crises and are insufficiently skilled in suicide risk recognition and safety planning. This results in an increasing number of children and adolescents experiencing extended boarding times in the ED while awaiting evaluation and disposition planning by a licensed mental health clinician. The role of ED clinicians is currently to stabilize and determine disposition of patients with mental illness. The system is completely encumbered by the limitations ED clinicians face in offering equitable, competent, timely, community-informed, and individually focused care for children and adolescents with unmet mental and behavioral health needs.
In a 2023 study of 28 551 children and adolescents evaluated for mental health conditions in the ED, less than one-third accessed an outpatient mental health visit in the following week and approximately 50% did not have an outpatient mental health appointment in the month after their ED encounter.4 Connection to outpatient mental health services is particularly poor among children and adolescents without prior or established outpatient mental health care. As a result, more than 25% of children and adolescents evaluated in the ED for mental health concerns visit the ED again for subsequent unmet mental health needs within 6 months.4 Insufficient community-based mental health services and poor linkage to care after an ED discharge have created a vicious cycle for children and adolescents: worsening and untreated mental illness, inability to access needed services in the community, returning to the ED in crisis, facing extended boarding times before evaluation, and discharging home again without additional supports in place. Timely outpatient mental health treatment linkage must be prioritized to decrease repeated ED visits and optimize outpatient mental health care...
Language: en |