The decision to bring a young patient to the ER for mental health concerns versus what can wait is challenging. As a general rule, a young person should be taken to the ER if the caregiver has any concern about their safety and/or the safety of others.
Lifelong Learning in Clinical Excellence | January 23, 2023 | 2 min read
By Mackenzie Sommerhalder, PhD, Johns Hopkins Medicine
The decision to bring a younger patient to the ER for mental health concerns versus what can wait is a tough one. On the one hand you are balancing, “Is this child safe at home right now?” and on the other hand you’re wondering, “What can the ER do for this child?”
So often, youth are sent to the ER just to wait for hours to be evaluated only to be sent home to follow up with their general mental health provider. Conversely, often a youth’s concerning reports are written off and they’re sent home rather than sent to the ER.
It’s important to remember that the purpose of the ER isn’t to diagnose or treat mental health concerns, but instead to assess risk/safety and determine “admit to the hospital” or “discharge home.” An ER will also establish a crisis/safety plan and help connect a young patient and their caregivers to mental health resources.
Though the decision to send a younger patient to the ER for mental health concerns is nuanced, here are a few things to consider:
1. The person is at risk of imminent harm to themselves or others.
2. A sudden, new, and unexplainable change in mental status, like agitation, confusion, hallucinations, mania, and/or catatonia.
3. “Harm to themselves or others” typically references suicidal ideation or homicidal ideation. A young patient with suicidal ideation or homicidal ideation should go to the ER if there’s an active plan to act on suicide or harm, as well as means and motivation to follow through on that plan. New suicide or harm also warrants a trip to the ER (in other words, the young patient has never experienced suicide or harm before.
4. New self-harm without suicide needs urgent attention, but does not necessarily warrant an ER visit. Instead, the patient may benefit from the development of a high-quality individualized safety/crisis plan that is agreeable to and feasible for both the patient and their caregivers (e.g., Stanley-Brown Safety Plan). The youth should also have a visit scheduled with a mental health provider within 24-48 hours. If the youth doesn’t currently have a mental health provider, the youth and their caregivers should be encouraged to contact a crisis resource.
5. Decisions about mental health concerns aren’t black and white, and are challenging to make when not a trained mental health provider. When in doubt, know that there’s a social worker, pediatric psychologist, and/or psychiatrist embedded within many pediatric specialties that can assist in determining if a young patient needs to go to the ER for mental health concerns.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.