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Youths with mental health conditions often turn to EDs

Creating an action plan for young patients with behavioral or emotional problems could help them receive appropriate care when they need it most and keep them out of the emergency department, says the lead author of a study. An action plan could address how patients should monitor their symptoms, what constitutes an emergency for the family and whom to contact in that situation. The study, in the June issue of Psychiatric Services, found that many youths who repeatedly go to the ED for mental health care are not there for what are considered psychiatric emergencies such as a suicide attempt or psychotic symptoms. Instead, they often have behavioral issues, which include verbal altercations and running away from home. Many patients already were being treated by an outpatient mental health professional. Although the study did not define this group, pediatric psychiatrist and study lead author Emily Frosch, MD, said it could include primary care physicians who are increasingly treating mental illness. The study authors said it is not clear why these patients go to EDs for treatment. Some possibilities include clinicians referring patients to an emergency setting for care and outpatient offices that are closed when a patient needs medical attention. The problem is that EDs rarely have on-site pediatric mental health specialists and might not be able to properly care for these youths. "Emergency rooms are not an optimal care setting for these youngsters," said Dr. Frosch, director of education and training in the Division of Child and Adolescent Psychiatry in the Dept. of Psychiatry and Behavioral Sciences at Johns Hopkins Children's Center in Baltimore. "That's why physicians should discuss with patients [and their families] when they might think about going to an ER. Then [the physician] can identify other resources that might be more helpful to them." Such resources could include support groups or programs to help prevent a health emergency, she said. Receiving outpatient care Researchers examined the medical records of 2,903 people age 3 to 17 who sought mental health care at the Johns Hopkins Children's Center, a pediatric hospital, between 2002 and 2009. Of those patients, 12% returned to the center's ED for care within six months of their initial visit. Researchers found that more than half of the return visitors presented with behavioral problems at both visits. Fewer than 10% of these patients had attempted suicide, and no more than 3% had psychotic symptoms. A majority of the youths were being seen by an outpatient mental health care professional. At the first ED visit, 71% of patients reported receiving outpatient mental health treatment. The figure climbed to 85% at the second visit. The study authors said further research is needed to determine why such individuals seek mental health care at an ED for non-emergency problems. "We need to understand why families who are already connected to outpatient providers continue to seek ER care, why providers send patients to the ER and what role, if any, ERs may play in the continuum of care for nonpsychotic, nonsuicidal patients," Dr. Frosch said. The full and original article can be found at: http://www.ama-assn.org/amednews/2011/06/20/hlsb0622.htm
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