Imagine the scenario: a parent, filled with dread, brings their child to the emergency room, not for a broken bone or a sudden fever, but for a crisis of the mind. The child may be struggling with overwhelming anxiety, expressing suicidal thoughts, or exhibiting aggressive behaviors. This isn’t a rare occurrence; rather, it has become an increasingly common, heartbreaking reality in emergency departments across the nation. The video above offers a poignant glimpse inside an ER’s psych room at Cook Children’s, revealing the profound challenges and dedicated efforts involved in caring for young patients experiencing pediatric mental health emergencies.
The Alarming Surge in Pediatric Mental Health Crises
A significant and troubling trend has been observed within emergency departments: a substantial increase in the number of behavioral health and mental health patients. Dr. Taylor Louden highlights this rise, noting that even younger children, some as young as eight or nine years old, are presenting with severe symptoms. The intensity of these crises often involves profound anxiety and deeply concerning suicidal thoughts, with children expressing feelings of not belonging and wishing they were dead. This surge in volume, coupled with the severity of cases, places immense pressure on an already stretched healthcare system.
The challenges are further compounded by resource limitations, particularly “bed space,” which refers to the physical beds available to house patients. This issue was exacerbated by the COVID-19 pandemic, as the inability to “double room” patients due to infection control protocols naturally decreased the total number of available beds. This reduction in capacity has led to incredibly stressful situations for families, who are often “trapped” in the emergency department for extended periods—hours, or even days—while staff desperately try to find appropriate placement for their children.
The Critical Role of ER Triage and Proactive Suicide Risk Screening
In the emergency department, the journey for a patient begins in triage. Here, a crucial first step involves asking a series of screening questions. If, based on the answers provided, a patient is deemed high-risk, they are immediately assigned a “one-to-one sitter” for continuous observation. This proactive approach is vital, as eloquently stated by Kara Dorman, who emphasizes the meaningful work performed by staff in asking these questions. Often, children may have never been asked about their struggles before, meaning their distress could have remained hidden if not for these dedicated screenings.
The impact of this screening process is profound and often life-saving. For example, in 2022 alone, 31,791 patients presenting with general medical complaints (not initially for behavioral health issues) were screened. Of this number, a striking 640 children were identified as being at risk for suicide, and among those, 22 were found to be actively suicidal at the time of their visit. These statistics underscore how many children, who enter the ER for a completely unrelated medical issue, are identified as having attempted suicide within the last 48 hours or expressing a desire to die. These efforts allow the staff to “catch these kiddos” before they can inflict further harm upon themselves, rerouting them toward the vital care they need.
Inside a Psych-Safe Room: Prioritizing Patient Safety in a Behavioral Health Crisis
For children identified as needing specialized care for a behavioral health crisis, placement into a “psych-safe” room is often necessary. At facilities like Cook Children’s, there are five such rooms specifically designed within the emergency department to prevent harm. These specialized environments are equipped with numerous safety features:
- Covered outlets: To prevent patients from self-harm through electrocution.
- Specialized beds with restraints: When a child is acting out, aggressive, or attempting to harm themselves or others, restraints can be applied to their wrists and secured to the bed frame to ensure their safety.
- Covered plumbing: Past incidents in other facilities have shown children tying ligatures around exposed plumbing underneath sinks, leading to tragic outcomes. Enclosing plumbing eliminates this risk.
- Enclosed TVs in lock boxes: This prevents patients from breaking the glass and using it to harm themselves or as an object to throw at staff members.
These rooms are meticulously designed to eliminate potential hazards, creating an environment where children can be safely monitored and cared for during their most vulnerable moments. While the ER has five dedicated psych-safe rooms, the broader facility includes a total of eight behavioral health rooms, encompassing an inpatient psychiatric unit.
The Strained System: Bed Space, Long Waits, and Systemic Challenges
Despite the dedication of staff and the provision of specialized rooms, the system itself faces immense strain. An average length of stay for a typical emergency department patient is approximately three hours. However, for behavioral health patients awaiting admission or transfer to a specialized unit, this wait dramatically extends to anywhere between seven and nine hours. Critically, some patients have endured stays exceeding 36 hours within these ER rooms, simply waiting for an available bed at an accepting facility, as psychiatric units are often full.
This prolonged waiting period has cascading effects. When a safe home environment cannot be identified, or no specialized bed is available, children are often admitted to the hospital’s medical side. This “ties up a medical bed,” further stressing the entire medical system by diverting resources from other patients who require those beds for physical ailments. Dr. Louden articulates the profound anguish visible on the faces of parents, who feel they have exhausted every available resource only to find themselves in a seemingly intractable situation. While ER staff “do the best we can,” a “slam dunk answer” is rarely available.
Fortunately, at Cook Children’s, the hospitalist group has agreed to help by taking these children from the emergency department to a medical floor, preventing them from languishing for days in the ER. This is a crucial distinction, as “other places, unfortunately, don’t have that luxury,” resulting in children being kept in the ER for days—a situation universally recognized as suboptimal, indicating that “the system’s broken.” The need is clear: an additional five psych-safe rooms could significantly alleviate some of this pressure.
Supporting Children and Families in Crisis
The challenges highlighted within the video regarding pediatric mental health emergencies are a stark reminder of a broader societal issue. Emergency rooms, by their very nature, are designed for acute physical trauma, not as long-term holding facilities for complex psychiatric needs. The increasing reliance on ERs as the “last resort” for children in mental health crisis underscores a critical shortage of preventative care, accessible outpatient services, and specialized inpatient psychiatric beds.
It becomes evident that a multi-faceted approach is required. This includes increased funding for child and adolescent psychiatric services, expanding community-based mental health resources to intervene before crises escalate, and educating the public on recognizing early signs of mental distress in children. Furthermore, continued advocacy is needed to expand specialized facilities and ensure adequate staffing within emergency departments and psychiatric units. The dedication of ER staff, who consistently go above and beyond to provide compassionate care within a broken system, is commendable, but the ultimate solution lies in systemic improvements that prevent children and families from reaching this painful “last resort” in the first place.
Behind the Psych Room Door: Your Q&A
What kind of mental health issues bring children to the emergency room?
Children are brought to the ER for mental health crises like severe anxiety, suicidal thoughts, or aggressive behaviors. These situations have become an increasingly common reality in emergency departments.
How does the emergency room identify children at risk for mental health issues?
When a child first arrives at the ER, they go through triage where staff ask screening questions. This helps identify children who might be at risk for suicide or other serious mental health problems.
What is a ‘psych-safe room’ in an emergency room?
A psych-safe room is a specialized room within the ER designed to prevent harm to children experiencing a behavioral health crisis. These rooms have features like covered outlets and enclosed plumbing to ensure safety.
What is a major challenge emergency rooms face when treating children with mental health crises?
A significant challenge is the lack of available beds in specialized psychiatric units, which leads to children waiting in the ER for many hours or even days. This puts a huge strain on both the healthcare system and the families.