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More Emergency Care Targets Kids in Crisis

There is more than one way hospitals can meet the need for specialized psychiatric services.

At Children's Memorial Hospital in Chicago, psychiatrist Richard Martini, M.D., directs an emergency department consultation service that provides on-site expert consultation to medical emergency department (ED) staff about patients with behavioral problems or mental illness.

As part of the department of child and adolescent psychiatry, the consultation service ensures the on-site presence of a child and adolescent psychiatry resident, psychology intern, and/or psychiatric nurse practitioner under Martini's supervision 24 hours a day. A social worker is also on site in the ED at night, Martini said.

He confirmed the large and growing part that mental illness plays in emergency department visits by children and teens.

"Our ED sees kids of all ages," Martini told Psychiatric News. "We have had very young kids as well as preteens and adolescents who have threatened to hurt themselves, and a large number of children who are aggressive; threaten other kids, siblings, and parents; set fires; and are engaged in a variety of other dangerous behaviors. These patients come to the ED because either the parents or the school feel they can't manage the children."

Ensuring adequate follow-up in the community for those patients not admitted to the hospital is a constant challenge. "We have patients that may not meet the criteria for imminent danger to themselves or others, but whom we feel uncomfortable putting on a waiting list for outpatient care that may be weeks long," he said.

In those cases, an urgent care outpatient clinic linked to the hospital will see the child within seven days, providing a short-term therapy program that addresses the most acute aspects of the child's condition. The urgent care clinic can then transfer the child to outpatient treatment or, in the case of deterioration, to day or inpatient hospitalization.

Martini estimated that between 350 and 400 psychiatric emergencies come to Children's Memorial Hospital every year. A collaborative relationship between the consultation service and the medical ED staff has allowed for special accommodations—with regard to space and resources—for managing especially aggressive patients.

"Our ED is very busy, with approximately 45,000 visits a year," he said. "[Our psychiatric patients] are only 1 percent of the patients who come through the door, but we get attention because of how different our patients are and how much time they require."

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