Young People in Crisis- Assessing Risk of Mental Health Patients in the Children`s Emergency Eeparment

Mental health (MH) disorders in children and young people (CYP) is on the rise with many CYP presenting acutely to the emergency department (CED) in ‘crisis’.CYP presenting to CED will be initially triaged and cared for by non-MH professionals while awaiting assessment by a children’s crisis team. There are often complex and multiple issues for these CYP in addition to their medical needs. A Mental Health Risk Assessment (MHRA) tool was introduced to help non-psychiatric trained medical staff in their initial and ongoing assessment.

To conduct a demographical analysis of CYP presenting to CED with acute MH issues in 2018 as well as evaluating our MHRA-tool in risk assessing these patients.

Methods: We collected data including age, gender, diagnosis and duration of admission for all CYP presenting to CED with acute MH problems over a one-year period. Following the introduction of a MHRA-tool we collected feedback from CED nurses and healthcare assistants over a 3-month period.

Results: There were 380 MH admissions to CED over a one-year period. Age of presentation was 9 -16 years of age. There was a female:male ratio of 2.7:1. 33% of CYP presented with self-harm. Nearly 40% of CYP presented with suicidal attempts or ideation. Over 80% were admitted for 24-hours, with the average wait for crisis team assessment being about 17 hours. Over 60% of nursing staff found the MHRA-tool a useful means to ask questions relating to potential risk in CYP during admission.

Conclusion: CYP with MH disorders who present to CED in ‘crisis’ often have multiple and complex issues.

Non-MH trained medical staff need a strategy and formal means to make a risk assessment while CYP await formal psychiatric review.

We recommend using a locally approved MHRA-tool to objectively risk stratify and assess such patients whilst waiting for a mental health assessment.