AAP addresses management of pediatric mental, behavioral health emergencies

In a policy statement issued by the American Academy of Pediatrics (AAP) and published online Aug. 16 in Pediatrics, recommendations are presented for improving emergency care for pediatric mental and behavioral health (MBH).

Mohsen Saidinejad, M.D., from the David Geffen School of Medicine at UCLA in Los Angeles, and colleagues highlighted strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.

In an accompanying technical report, the authors note there has been an increase in MBH visits of children and youth to emergency departments in the United States, with reasons for these visits ranging from suicidal ideation, self-harm, and eating and substance use disorders to behavioral outbursts, aggression, and psychosis. Despite this increase, the health care system does not have the capacity to screen, diagnose, and manage these patients.

The authors recommend developing emergency department facility transfer protocols involving emergency medical services for children, including appropriate referrals to psychiatric crisis units, which could provide short-term stabilization and referrals. Development of telehealth emergency psychiatric medical control is recommended to identify and divert low-acuity patients to facilities equipped to manage MBH conditions. In addition, the AAP recommends that existing mental health mobile crisis teams be activated to be able to respond as necessary, and resources should be provided for prehospital personnel in acute management of MBH emergencies.

Emergency department staff should be provided with resources related to recognition and provision of initial care to children and youth with potentially increased risks for MBH concerns. Expansion of telehealth consultation should be explored, especially in resource-limited areas or during disease outbreaks. The AAP also recommends advocating for community-based behavioral services that use a culturally sensitive, patient-centered approach to identify and manage concerns before development of an emergency condition. An increase in MBH research funding is necessary to screen and identify those at risk and connect with the appropriate resources.

"A dedicated multipronged, multidisciplinary approach will be necessary to provide patient-centered, trauma-informed services to improve the care of children and youth with MBH emergencies," the authors write.

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