Stories about: teenagers

Delivering psychiatric care in the ED: Keeping adolescents in crisis out of limbo

Suicidal teens who come to the emergency room for help are often kept there until an inpatient bed becomes available, which can take hours or days. Elizabeth Wharff is changing the standard of care by providing family-based psychiatric treatment right in the ED.

When teenagers come to an emergency department expressing suicidal thoughts or after a suicide attempt, the accepted model of care is to evaluate, then either send them home or keep them in the ED until an inpatient psychiatric bed becomes available.

The wait for an inpatient bed can take hours, even days. No psychiatric treatment is given. The child is simply “boarded” – kept waiting in the ED under supervision, a practice that can increase distress for the child and family, while taking ED beds out of circulation for other acutely ill patients.

“Generally speaking, there is no history of providing psychiatric treatment in the emergency room setting,” says Elizabeth Wharff, director of the Emergency Psychiatry Service at Children’s Hospital Boston. “Since the late 1990s, we have seen a significant increase in the number of cases where an adolescent comes to our emergency room with suicidality and needs inpatient care, but there are no available psychiatric beds anywhere in the area.”

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