Wellness 911

Abstract

EPs can offer encouragement and provide information that is transformationalFigureFigureFigureFigureAre psych patients your favorite patients in the emergency department? Did I hear a guffaw? What if I told you they are one of mine (LC)? It's true. Let me explain. I transitioned out of the adult ED after an episode of burnout several years ago, and have worked primarily in a pediatric ED ever since. Pediatric psychiatric visits have exploded in frequency in recent years. It was rare to see a suicidal patient in the peds ED when I was in residency training. Fast forward to today. I come into work at times and find half of our beds filled with psych holds. The pediatric mental health crisis has spiraled out of control. Acutely suicidal patients generally require inpatient treatment, but is there anything we can do to help make this hospitalization their last hospitalization? Is there anything we can say or do to improve their outcomes after discharge? This is where these patients become my favorites. Often in emergency medicine, we feel as though we slap Band-Aids on chronic problems, but make no real difference in people's lives. But we can offer words of encouragement and provide information that has the potential to be transformational for these patients and their families. Looking to the Future How do we do this? First, show that we care. Many of these children have experienced traumatic experiences. Many come from home situations where parents are unavailable for various reasons. Sometimes just being a listening ear for a few moments, providing a moment of human connection and empathy, can make a significant difference for these children. We can also ask about their futures. Many of these young people feel stuck in unfortunate situations, not realizing that they have so much of their lives ahead of them, so many opportunities for change, growth, and improvement. Asking children what they want to be when they grow up and encouraging them in the belief that they can become whatever they want to be helps provide a future focus and develops what psychologists call prospection—the mental representation and evaluation of possible futures. Discussing their favorite hobbies and activities, pets, and family members can help do the same. Research has demonstrated a link between positive future focus and less suicidal ideation. (Front Psychiatry. 2022;13:915007; http://bit.ly/3zufcgd.) We can explore their health habits. Many evidence-based lifestyle modifications can help ease depression symptoms. Surprisingly, mental health service providers don't always discuss these with their patients. Exercise and Nutrition One of the most important health habits is exercise. A recent meta-analysis showed brisk walking for 2.5 hours a week can improve depression symptoms by up to 25 percent. (JAMA Psychiatry. 2022;79[6]:550; http://bit.ly/3lTjsCt.) That could mean the difference between suicidal and not suicidal. Getting outside and getting the heart rate up for even a few minutes a day can create a substantial improvement in symptoms. Nutrition is also important. Depression is an inflammatory condition, so it's no surprise that inflammatory foods can increase symptoms of depression while anti-inflammatory diets reduce the likelihood of adolescent depression. A quick reminder of which foods are helpful and which to avoid could help this population. Discuss screen use. Numerous studies have identified a positive association between screen use and depression in adolescents. Addressing the issue during the crisis moment in the ED helps create awareness of the dangers of excessive screen use and provides empowerment to parents who may not realize they need to—or are able to—apply boundaries to their children's screen use. My typical pediatric psych patients are on their devices for eight or more hours daily. I am usually able to run through all these strategies in a five-minute spiel during my evaluation of the patient. I later include them in any written instructions given at discharge or transfer to a psychiatric facility. Almost invariably, families are appreciative of the time I spend sharing this information, and I feel as though maybe I have made a difference for these children and their families. Your mileage may vary, but I encourage you to give these simple interventions a try. They might just save a life! Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].