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Patients presenting at SickKids with mental health concerns are on the rise


The Department of Psychiatry and the Emergency Department work together, and​ with teams across the hospital, to handle the increase in mental health presentations at SickKids.  Above, Dr. Suneeta Monga and Dr. Jason Fischer, Division Head, Emergency Medicine.
This week on sickkidscmh.ca, we celebrate Children’s Mental Health Week. For our fourth instalment of this five-part series, Dr. Suneeta Monga, Associate Chief of Psychiatry, SickKids, outlines the numbers of children seen at the hospital who require mental health services and why, as caregivers, we must be aware of this need. 

Jasmine, 15, presents at the SickKids Emergency Department (ED) after taking a planned overdose in a suicide attempt. She tells the psychiatrist about the evolution of her depression: how she has been feeling sad and down since the start of her grade 10 school year; that little things her friends would say and do would irritate her; that she tried to smile and tell herself it was nothing. How early in January she told her mom that she was feeling tearful at times, and her mom told her it was “just being a teenager.” How by March she stopped wanting to hang out with her friends and started thinking about ending her life. How she planned her suicide attempt over several days, feeling like she was just going through the motions. How she felt hopeless, couldn’t pull herself out of her “slump,” and just wanted to end things.  
While the case of Jasmine is fictional, her story is not. She is a composite of what is seen at SickKids, and reflects the experiences of an increasing number of children and youth who present at the EDs of hospitals across North America. Between 2007 and 2015, there has been a doubling in the number of children and youth presenting with suicidal ideation or suicide attempt to these EDs according to a recently published study in JAMA Pediatrics.  
Here at SickKids, we have seen a 66 per cent increase in mental health presentations to the ED from 2016 to 2018. The Psychiatry Urgent Care Clinic, which opened in January 2018 and provides urgent psychiatric assessment and brief crisis intervention, has seen an increase of nine per cent in youths referred to the clinic over the same eight-month period in 2018 as compared to 2017, with an anticipated ongoing similar increase year to year. 
The Mental Health Inpatient Unit at SickKids has also seen a surge in the number of youths requiring inpatient psychiatric admissions. Similarly across the GTA, there have been periods during which there can be no movement across mental health beds due to each psychiatry unit being over capacity.  
Youth mental health disorders is a pressing concern not only in the ED but across the hospital – US pediatric hospital studies suggest rates of close to 25 per cent of youths in medical or surgical units also have a mental health disorder. A retrospective chart review of over 55,000 charts at SickKids between 2013 and 2017, however, recorded that only 11 per cent of youths in medical or surgical units also had a mental health concern. This suggests that we are likely missing many youths with both concerns. Awareness of mental health concerns continue to improve at SickKids as noted by the more than doubling number of referrals to the Psychiatry Consultation Liaison service, which provides psychiatric evaluation for children and youth across medical/surgical units, from just over 200 in 2015/16 to 450 in 2018/19.   
These numbers highlight the importance of checking in with children and youth on how they are doing and consulting psychiatry when concerns arise and further support is required.  Additionally, our mental health hub​ on the AboutKidsHealth website is a great resource for clinicians, parents and youth about mental health well-being and mental health disorders.