Anxious, Suicidal Teens Often End Up in Overwhelmed ERs. How Can We Improve Systems to Help Everyone?

The COVID-19 pandemic has been detrimental to the mental well-being of children and teens across America and experts are ringing the alarm. Suicide is the second leading cause of death among 12 to 17 year-olds in the United States and the adolescent suicide death rate has steadily increased in the last decade. With the impact of the pandemic, particularly on young people, deficiencies and lack of capacity in the mental health system have been brought to light. Like other aspects of the pandemic, this has disproportionally impacted communities of color. Youth with mental health concerns are brought to emergency departments (ED) as a last resort for mental health emergencies. As the number of children presenting with stress, anxiety, and depression has skyrocketed throughout the country, EDs are overwhelmed and struggling to adjust and cope with the need for psychiatric services. Many ED providers feel inadequately trained or prepared to manage this incredible demand.

A recent New York Times article noted how few hospitals are prepared for an influx of anxious, depressed, and potentially suicidal youth. Yale Pediatrics’ Marc Auerbach, MD leads a program set out to improve just that: the federally funded Emergency Medical Services for Children (EMSC), Innovation and Improvement Center (EIIC).

The entire continuum of pediatric emergency care is affected by incoming cases of mental health care needs. Hospitals and health systems CAN be prepared. There are resources that every hospital can learn from and implement. Let’s all do our part to support these kids and their families when they need it most.

Below are some of the resources collated or developed by EMS for Children and its federal partners:

1. ID systems/providers/patient issue - Ex: Most EDs not ready for pediatric mental health (especially in rural areas)
   1. More suicidality/attempts
   2. More racial disparities
2. ED Suicide Screening Toolkit for youth from the National Institutes of Mental Health (NIMH)- ASQ Youth
3. Education on care for a child with developmental and intellectual disabilities from TREKK (EIIC partners in Canada)
4. HRSA Critical crossroads toolkit provide solutions for the system of care to “better prepare hospital emergency departments to manage and coordinate care for children and adolescents in mental health crisis” @EMSCImprovement is working to leverage critical crossroads to develop a PEAK (Pediatric Education and Advocacy Kit) Mental health toolkit launch planned for mid-June 2021.
5. All ill and injured children deserve equitable/optimal care whenever, wherever it is needed- Big challenge: prehospital +/- general hospitals +/- rural, mental health care is a human right
6. EIIC Telehealth collaboratives launched in January 2021 and will extend through June 2021. The focus of this collaborative is to evaluate the impact of public health crises on children and youth with special health care needs and those with behavioral health emergencies, to assess telehealth capacities particularly in low resource areas such as rural, tribal, and other remote access areas in all US states and territories. The collaborative aims to provide guidance and support to improve access to emergency pediatric services in these and other areas.
7. EIIC Pediatric Readiness Quality collaborative (PRQC): Aims to improve day-to-day pediatric readiness and to assure high quality care for all children in the United States regardless of state or region. The first quality collaborative involved more than 140 hospitals from 17 states. The second quality collaborative is currently in planning.
8. Other EMS for Children funded programs include the Targeted Issues Grants, aiming “to support strategies to improve the quality of pediatric care delivered in emergency care settings through the implementation of pediatric emergency care research and innovative cross-cutting projects”
9. State Partnership Programs, “aiming to support demonstration projects for the expansion and improvement of emergency medical services for children who need treatment for trauma or critical care”, , State Partnership Regionalization of Care (SPROC), which is designed to identify and develop resources, Pediatric Emergency Care Applied research Network (PECARN), aiming to conduct multi-institutional research on the prevention and management of acute illnesses and injuries in children and youth of all ages”. The PECARN ED STARS study developed and is testing a brief, personalized, computer-based suicide risk screening tool for teenagers.
10. The EMS for Children also offers many other resources specific to mental health to support providers and patients. You can follow this dynamic resource development on the EIIC web portal, or you can follow us on Twitter. If you have any questions, please contact EIIC directly.

Formed in 2016, the EIIC, part of the Health Research and Services Administration (HRSA), has developed programs to help pre-hospital personnel and ED clinicians, patients and their families by providing education and resources focused on mental health emergencies. Support for the EIIC comes from HRSA funds and in collaboration with EMS for Children stakeholders including the State Partnership (SP) Programs and Targeted Issues (TI) Grantees, the National EMS for Children Data Analysis Resource Center (NEDARC), The Pediatric Emergency Care Applied Research Network (PECARN), and the EIIC, along with partner organizations such as the American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), Emergency Nurses Association (ENA), National Association of State EMS Officials (NASEMSO), and American College of Surgeons Committee on Trauma (ACS-COT).