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Understanding Psychiatric Emergencies

Kyle Caldwell, M.Ed., LPCC-S
As a mental health clinician working in the emergency department, this is the time of year where we begin seeing an increase in the number of patients coming in for psychiatric evaluations. Many of our patients are being referred to us by their schools, therapists, pediatricians, and even the police. Despite the large volumes of patients arriving to due to psychiatric concerns, the vast majority of them are being discharged with a plan to follow up with their outpatient providers. In my experience, many of these patients are not necessarily having psychiatric emergencies but rather do not know what else to do, or where else to go. I would like to spend some time comparing the difference between Psychiatric Emergencies and Psychiatric Non-Emergencies.
Psychiatric Emergencies
Simply put, a psychiatric emergency is when a person has become a danger to themselves or others in the community. A common example of this would be teenager who has been having increased suicidal thoughts, has developed a plan, and has the intention to act on it. What makes this an emergency is the nature of the threat being imminent. The parents of the teenager taking immediate action could mean the difference between life and death.  Of course, the degree to which the teenager is willing to share enough for parents to make an informed decision may vary, in which case the parents can call 988 (National Suicide Prevention Hotline) or the Psychiatric Intake Response Center (513-636-4124) here at Cincinnati Children’s Hospital in order to get further guidance.
Now, there are certainly other situations that may constitute psychiatric emergencies that are not as obviously related to imminent danger such as psychosis and mania. Psychosis is a condition that could be best described as someone experiencing a break from reality. This may include auditory/visual hallucinations, disorganized thoughts and speech, psychomotor agitation, and sometimes aggressive behaviors. Mania is a symptom usually associated with Bipolar I disorder and may look like someone having racing thoughts, pressured speech, and decreased sleep for days, grandiosity, and sometimes even delusions. In such cases, a person’s behavior can become very unpredictable and very impulsive making an ED visit warranted.
Psychiatric Non-Emergencies
It’s hard to make an exhaustive list for situations that are not necessarily emergencies so instead I’ll try to offer up some relevant examples. We have a lot of patients being referred for things like self-harm, angry outbursts, destroying property, parent-child conflict, disruptive behavior, anxiety, etc. In cases such as these I would not recommend immediately referring a child to the ED, but rather first making a phone call to consult with a professional. I would suggest reaching out to the child’s primary care provider, therapist or psychiatrist, if they have one. If they do not, or they’re unavailable, you can call the Psychiatry Intake Response Center. We can help triage the problem to determine if it needs to be addressed in the ED or not. In many cases, an appointment can be made with our Bridge Clinic to evaluate these issues in an outpatient capacity. They can also help with offering outpatient resources for follow up. Another great option is Best Point Behavioral Health mental health urgent care (5051 Duck Creek Rd, 513-272-2800). They can offer mental health assessment and intervention on a walk-in basis. Lastly, most counties have a Mobile Response and Stabilization Service – mental health providers who can come into the home to provide psychiatric assessment of your child. Simply call 988 and describe your concern.
Understanding Psychiatric Emergencies
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