Reflections: When Moral Injury and Compassion Fatigue Strike: Apologize to Patients, Forgive Ourselves

Area of Science:

• Psychiatry
• Public Health
• Emergency Medicine

Background:

• The COVID-19 pandemic has significantly impacted mental health services.
• Child and adolescent psychiatrists, particularly those in emergency departments (EDs), have faced unprecedented challenges.

Observation:

• Emergency departments nationwide have experienced a surge in patient acuity.
• Extended wait times for inpatient beds have become common.
• There has been a systemic reduction in alternative care settings, limiting options for patient discharge.

Findings:

• Increased patient severity in EDs during the pandemic.
• Prolonged boarding of patients awaiting inpatient psychiatric beds.
• Decreased availability of step-down care facilities.

Implications:

• The closure of alternative care levels exacerbates the strain on emergency psychiatric services.
• Urgent need for increased capacity and accessibility in mental health care.
• Potential long-term consequences for child and adolescent mental well-being due to service gaps.