Caring for adolescents with mental health problems: challenges in the emergency department

To explore management issues in adolescents with mental health problems who presented to a children's hospital emergency department (ED).

Retrospective chart review of all mental health presentations of adolescents (12-18 years) to a tertiary children's hospital ED, over a 1-year period (2003-2004). Patients were identified based on a search of the electronic ED log. Medical and mental health records were manually abstracted.

There were 203 presentations during the study period. Eighteen per cent of patients presented more than once. Mean age was 14.7 years, 73% were female and 67% presented after 6 pm. Fifty-seven per cent presented with non-accidental overdose, self-harm or suicide risk. There were 110 security incidents in 26% of presentations during the ED stay. A total of 47% were admitted, 27% to the medical inpatient service and 20% to a psychiatric inpatient facility.

Adolescent mental health presentations to the ED require a high number of ED, mental health and inpatient service resources. Security incidents occur frequently. We propose changes to address identified problems. These include redesigning the physical structure of the ED, more mental health training and support for ED staff, better access to mental health records and crisis plans for adolescents at risk, and improved after-hours mental health services for children and adolescents.