New Guidance on Managing Pediatric Mental Health Emergencies
October 3rd, 2016
PROVIDENCE, RI – The rates of children and adolescents presenting to the emergency department with mental health and behavioral emergencies has soared, with as many as 70% of ED patients screening positive for at least one mental health disorder,and 45% potentially having a mental health problem resulting in impaired psychosocial functioning.
That’s according to information provided by the American Academy of Pediatrics (AAP), which recently released a set of new clinical reports to assist ED clinicians and others in caring for children and adolescents with acute mental health and behavioral problems. The two reports, Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part 1: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies and Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms, along with executive summaries, are due to be published in the September issue of Pediatrics.
Lead author Thomas H.Chun, MD, MPH, of Brown University noted that an especially worrisome trend is the rise in “boarding” of psychiatric patients in the ED and inpatient pediatric units for extended stays of days or even weeks. He pointed out in an online AAP article that the practice, while not well-researched, appears to be a problem because of the lack of mental health services in those settings.
The reports were written from the perspective of ED clinicians and are designed to help guide them in caring for children and adolescents during an acute crisis, Chun said.
Part I focuses on patients presenting to the ED with a chief complaint involving mental health problems. It includes information on medical clearance of pediatric psychiatric patients, suicidal ideation and suicide attempts, involuntary hospitalization, as well as coordination of care with the medical home. Among the issues discussed is restraint of agitated patients, including a comparison of verbal, chemical, and physical restraint methods.
In Part II, the authors discuss challenging patients with primarily medical or indeterminate presentations in which an underlying mental health condition remains unclear or is a complicating factor. Other topics covered in the report include:
- somatic symptom and related disorders;
- adverse effects to psychiatric medications (including antipsychotics, neuroleptic malignant syndrome, and serotonin syndrome); and
- children with special needs in the ED (including autism spectrum and developmental disorders).
Because mental health conditions frequently go unrecognized by clinicians, the second part of the report also includes information about rapid mental health screening tools, including screens for depression, anxiety, post-traumatic stress, and substance abuse.
Chun noted that vague somatic complaints such as headache, gastrointestinal tract distress, back pain, or concern for a sexually transmitted infection, among others, can mask underlying mental health conditions.
The reports were developed by the pediatric emergency medicine committees of the AAP and the American College of Emergency Physicians (ACEP).