Mental Health Problems in Children and Adolescents in the Emergency Department: “The Times They Are A-Changin'”

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To the Editors:
In 2016, almost the same number of patients were admitted to the surgery ward and to the neuropsychiatric ward of our hospital (92 versus 88 patients, respectively), among those who visited our emergency department (ED). Given the very low overall admission rate (3%) of our ED, up to 13% of all admissions were to the neuropsychiatric ward. Moreover, we have requested 470 urgent neuropsychiatric consultations in a year, which is more than the times we called the surgeon (Table 1). These data are quite extraordinary and suggest some considerations. We work in the ED of the tertiary level children's hospital of Trieste, in the northeast of Italy, and most of the patients accessing our department live in town or in the surrounding area. We are experiencing a year-by-year increase in ED visits related to children's and adolescents' mental health problems. The number of admissions in the neuropsychiatric ward increased 4-folds, and the number of urgent neuropsychiatric consultation requests almost doubled in the past 10 years (Table 1). We are aware that a portion of those patients had a neurological disease, but managing children with somatic symptoms, anxiety, self-harm, substantial abuse, behavioral disorders, and even suicidal ideation is becoming our daily ED practice. Our experience is in line with the international literature that underlines how these disorders are always more frequent in this age group.1–3 Having neuropsychiatry specialists available for urgent consultation is an unusual asset, nevertheless, managing patients and families with these complex presentations in a setting like a pediatric ED may be time consuming and troublesome. Presenting symptoms may mimic an organic disease or may not fit any known psychiatric disorder. Nonetheless, the ED evaluation might be the only point of medical contact that these young people have4 and a unique window of opportunity to identify and support them. According to this evidence, it is nowadays mandatory that every ED pediatrician or emergency physician caring for adolescents in a general ED have specific training in the evaluation and management of children and adolescents with a mental health problem, to limit useless tests and recognize the risk for these patients and families if their conditions are not diagnosed and managed. Prompt recognition, referral, and treatment of mental health problems through the ED may significantly affect the long-term prognosis of these patients. As Bob Dylan sung, “The times they are a-changin'”, and our departments should be prepared for the best possible support.
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