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The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies
Mohsen Saidinejad1, Susan Duffy2, Dina Wallin3
1Department of Clinical Emergency Medicine & Pediatrics, David Geffen School of Medicine at UCLA, Institute for Health Services and Outcomes Research, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, and Department of Emergency Medicine, Harbor UCLA Medical Center, Los Angeles, California.
Insights
Pediatric mental and behavioral health (MBH) emergencies strain emergency departments (EDs). Improving care requires better infrastructure and coordination for children and youth facing MBH crises.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Healthcare Systems Analysis
Background:
- Pediatric mental and behavioral health (MBH) emergencies are increasing nationwide.
- Emergency departments (EDs) serve as a critical safety net due to inadequate community infrastructure.
- Children and youth present with diverse MBH emergencies, including depression, suicidality, and disruptive behaviors.
Purpose of the Study:
- To address the growing challenge of pediatric MBH emergencies in emergency medical services.
- To highlight strategies and resources for enhancing emergency care delivery for pediatric MBH.
- To inform policy and practice for improving the care of youth with MBH conditions.
Main Methods:
- Policy statement and companion technical report development.
- Review of challenges in pediatric MBH emergency care.
- Identification of system-level coordination strategies.
Main Results:
- EDs face significant challenges including personnel shortages, capacity issues, and limited access to mental health professionals.
- Prolonged ED stays and boarding negatively impact patient care and operational efficiency.
- Lack of outpatient resources post-ED discharge exacerbates the problem.
Conclusions:
- System-level coordination of care is essential for improving pediatric MBH emergency services.
- Recommendations and resources are needed to optimize emergency care delivery for children and youth with MBH conditions.
- Addressing infrastructure and resource gaps is crucial for effective MBH emergency management.
Abstract:
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure; challenges with timely access to a mental health professional; the nature of a busy ED environment; and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affect patient care and ED operations. Strategies to improve care for MBH emergencies, including systems-level coordination of care, are therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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