Issues in pediatric psychiatric emergency care

Introduction: Approximately 10% of the population under age 18 have a psychiatric illness that warrants treatment, yet only half of those with an identified serious mental disorder actually obtain an appointment with a child mental health specialist, and even fewer receive specialty treatment. By comparison, the marked growth nationally in the number of emergency department (ED) visits for psychiatric problems in those under 18 years of age suggests that this has become an alternate source of mental health care for youths. Given the persistent increase in these volumes, it is imperative that ED care settings develop strategies to address the concerns of these youths and families in an efficient and effective manner. This chapter describes strategies for evaluating youths with emotional and behavioral conditions seeking acute care in EDs. Assessing a child with mental health issues requires several steps. In the discussion that follows, each of the steps are explored in greater detail. These steps can be completed sequentially or concurrently, depending on the situation, but whichever method is used, a careful consideration of each step is warranted.