Why an On-site Inpatient Pediatric Psychiatric Unit Is Needed to Improve Mental Health Care in the Pediatric Emergency Department of Lenval Hospital, Nice, France

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To the Editors:
Admissions of children and adolescents for psychiatric reasons are common in pediatric emergency departments and can be severe: behavioral disorders, acute agitation, suicidal ideation or attempted suicide, self-harm, and so forth.1
These consultations lead to management difficulties in the pediatric hospital.1 They require rapid response to the distress of patients and their families and can mobilize significant human resources, particularly in the case of violent behaviors.
According to Sheridan et al,2 a childcare unit dedicated to child psychiatry would improve the quality of this care. However, most French pediatric emergency units do not have such facilities, so admissions are carried out within pediatric emergencies by nonspecialized staff.
At the Lenval Hospital, CHU (University Hospital) of Nice, France, we registered 57,862 admissions in 2014 compared with 51,292 in 2011, an increase of 12.8% (4% per year). The number of admissions of children for psychiatric reasons had increased from 472 in 2011 to 1092 in 2014, an increase of 76% (25% per year) and 1.8% of the total number of consultations.
The rate of hospitalization of children for psychiatric reasons was 11% to 32%, according to age, whereas for the other reasons for hospitalization, it ranged between 4.5% and 6.1%.
Finally, we showed that 20% of consultations in child psychiatry required a treatment time of more than 4 hours, compared with 6% only for the other grounds of admission.
These data (long consultation time and high hospitalization rate) highlight the difficulty in managing childhood psychiatry pathologies, with its complex, chronic, and comorbid aspects.
Thus, the increase in child psychiatric remedies in pediatric emergencies in recent years requires improving the therapeutic path of patients as soon as they arrive, with the creation of units devoted to child psychiatry and the recruitment of trained paramedics. Such a project is being studied at the CHU in Nice, and it will be necessary to measure its impact on the quality of care.
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