Emergency Mental Health Research Articles

Effectiveness of Emergency Mental Health Promotive Gadget Addiction in Adolescents Using a Mindfulness Attention Awareness Educational Approach

Gadgets among teenagers are a must because sophisticated features can use communication facilities, in the form of messages, entertainment facilities in the form of music, playing games, internet facilities, so gadget technology changes the atmosphere of solitude to become more lively and lively. After counseling, it is hoped that participants will know and apply the management of prevention and handling of mental health emergencies addicted to gadgets. The method used in counseling is the lecture method conducted online or question and answer discussion. The media used in counseling are PPT, leaflets, educational videos, SOP video tutorials for mindfulness exercises and applications to support activities online or online. Based on age, the majority (52.4%) of respondents were 17 years old, the characteristics of the sexes were obtained by the majority (66.7%) of respondents who were female.

Effectiveness of Emergency Mental Health Promotive Gadget Addiction in Adolescents Using a Mindfulness Attention Awareness Educational Approach

Gadgets among teenagers are a must because sophisticated features can use communication facilities, in the form of messages, entertainment facilities in the form of music, playing games, internet facilities, so gadget technology changes the atmosphere of solitude to become more lively and lively. After counseling, it is hoped that participants will know and apply the management of prevention and handling of mental health emergencies addicted to gadgets. The method used in counseling is the lecture method conducted online or question and answer discussion. The media used in counseling are PPT, leaflets, educational videos, SOP video tutorials for mindfulness exercises and applications to support activities online or online. Based on age, the majority (52.4%) of respondents were 17 years old, the characteristics of the sexes were obtained by the majority (66.7%) of respondents who were female. Insight was obtained that almost half (47.6%) of respondents considered themselves addicted to gadgets, almost half of respondents (47.6%) used gadgets with a duration of 5-6 hours, almost half of respondents (42.9%) used gadgets 11-12 times/day, almost half of the respondents (38.1%) wake up in the morning and use gadgets ≤ 6 minutes and 6-30 minutes, almost half of the respondents (47.6%) use gadgets for social media purposes and almost all of respondents (81%) experienced gadget addiction based on (SAS-SV).

National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

Mental health emergency presentations across the Barwon South West region in Victoria, Australia: An epidemiological investigation.

To examine mental health emergency presentations across the Barwon South West, Victoria, Australia - an area comprising a range of urban and rural localities. This is a retrospective synthesis of mental health emergency presentations across the Barwon South West (1 February 2017-31 December 2019). De-identified data were obtained from individuals who presented to EDs and urgent care centres (UCCs) within the study region, who had a principal diagnosis of a Mental and Behavioural Disorder (codes F00-F99). Data were sourced from the Victorian Emergency Minimum Dataset and Rural Acute Hospital Database Register (RAHDaR). Age-standardised incident rates for mental health emergency presentations were calculated for the whole sample and for local government areas. Data on usual accommodation, arrival transport mode, referral source, patient disposition and length of ED/UCC stay were also obtained. We identified 11 613 mental health emergency presentations, with neurotic, stress-related and somatoform disorders (n = 3139, 27.0%) and mental and behavioural disorders due to psychoactive substance use (n = 3487, 30.0%) being the most frequent types of presentations recorded. The highest age-standardised incidence rates (mental health diagnosis per 1000 population/year) were in Glenelg (13.95), whereas Queenscliffe had the lowest incident rates (3.76). Most presentations (n = 3851, 33.2%) tended to occur for individuals aged between 15 and 29 years. Neurotic, stress-related and somatoform disorders and mental and behavioural disorders due to psychoactive substance use were the most frequent types of presentations recorded across the sample. RAHDaR represented a small but meaningful contribution to the data.

National preparedness for 988—the new mental health emergency hotline in the United States

988, a national mental health emergency hotline number, went live throughout the United States in July 2022. 988 connects callers to the 988 Crisis & Suicide Lifeline, previously known as the National Suicide Prevention Lifeline. The transition to the three-digit number aimed to respond to a growing national mental health crisis and to expand access to crisis care. We examined preparedness throughout the U.S. for the transition to 988. In February and March 2022, we administered a national survey of state, regional, and county behavioral health program directors. Respondents (n = 180) represented jurisdictional coverage of 120 million Americans. We found that communities throughout the U.S. appeared ill-prepared for rollout of 988. Fewer than half of respondents reported their jurisdictions were ‘somewhat’ or ‘very’ prepared for 988 in terms of financing (29%), staffing (41%), infrastructure (41%), or service coordination (47%). Counties with higher representation of Hispanic/Latinx individuals were less likely to report being prepared for 988 in terms of staffing (OR: 0.62, 95 %CI: 0.45, 0.86) and infrastructure (OR: 0.68, 95 %CI: 0.48, 0.98). In terms of existing services, sixty percent of respondents reported a shortage of crisis beds and fewer than half reported availability of short-term crisis stabilization programs in their jurisdictions. Our study highlights components of local, regional, and state behavioral health systems in the U.S. that require greater investments to support 988 and mental health crisis care.

METER (Mental health emergency response) program: Findings of psychological impact status and factors associated with depression, anxiety and stress among healthcare workers in public hospital in Malaysia during the COVID-19 pandemic.

The COVID-19 pandemic has become the greatest challenge of the new millennium. Most healthcare workers (HCWs) experienced unprecedented levels of workload since the pandemic. This study aims to identify the prevalence and factors of depression, anxiety and stress among HCWs in Malaysian healthcare facilities in the midst of the pandemic due to the SARs-CoV-2. An emergency response programme on mental health was conducted from June to September 2020. A standardized data collection form was distributed among the HCWs in the government hospital in Klang Valley. The form contained basic demographic information and the self-reported Malay version of the Depression, Anxiety and Stress scale (BM DASS-21). Of the1,300 staff who attended the Mental Health and Psychosocial Support in Covid-19 (MHPSS COVID-19) programme, 996 staff (21.6% male, 78.4% female) completed the online survey (response rate: 76.6%). Result showed that staff aged above 40 years old were almost two times more likely to have anxiety (AOR = 1.632; 95% CI = 1.141-2.334, p:0.007) and depression (AOR = 1.637; 95% CI = 1.1.06-2.423, p:0.014) as compared to staff who were less than 40 years old. Those who had direct involvement with COVID-19 patients were likely to suffer stress (AOR = 0.596; 95% CI = 0.418-0.849, p:0.004), anxiety (AOR = 0.706; 95% Ci = 0.503-0.990, p:0.044) and depression (AOR = 0.630; 95% Ci = 0.427-0.928, p:0.019). HCWs with stress (AOR = 0.638; 95% CI of 0.476-0.856, p = 0.003), anxiety (AOR = 0.720; 95% CI 0.542-0.958, p = 0.024) and depression (AOR = 0.657; 95% CI 0.480-0.901, p = 0.009) showed less confidence to treat critically ill patients and need psychological help during outbreak. This study showed the importance of psychosocial support to reduce psychological distress among HCWs when working or coping during the COVID-19 pandemic or outbreak.

APA’s Government, Policy, and Advocacy Update (April 2023)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (April 2023)Search for more papers by this authorPublished Online:23 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.4.16APA Expresses Support for SAMHSA Expanding Access To Outpatient Treatment ProgramsThe Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed a rule to make permanent some regulatory flexibilities for opioid treatment programs to provide patients with extended take-home doses of methadone. APA provided comments on the rule, supporting several of its provisions while also offering recommendations.“Methadone is a particularly effective form of MOUD [medications for opioid use disorder],” APA’s letter stated. “Unfortunately, the regulations governing methadone access have created significant barriers to care for many of those who need and want treatment.” The flexibilities for prescribing methadone that SAMHSA has allowed during the COVID-19 public health emergency “served as a starting point for reimagining methadone access in this time of vital need,” the letter continued.Specifically, APA expressed support for SAMHSA’s efforts to change regulatory language to reduce stigma toward people who use drugs or have an opioid use disorder (OUD); SAMHSA’s collaboration with the Drug Enforcement Administration to facilitate mobile medication units and increase methadone treatment for underserved populations; and SAMHSA’s proposal to eliminate the requirement that patients must have a one-year history of OUD to qualify for methadone treatment.Further, APA questioned some provisions, including limiting methadone treatment to people with moderate to severe OUD and excluding those with mild OUD. In the letter, APA also suggested that SAMHSA provide guidance on methods to ensure quality counseling services through, or coordinated with, the opioid treatment program.APA’s Letter to SAMHSA in Response to SAMHSA’s Proposed Rule on Methadone Access APA, AMA Urge CMS to Finalize Prior Authorization ReformsIn a letter to Chiquita Brooks-LaSure, M.P.P., the administrator of the Centers for Medicare and Medicaid Services (CMS), the AMA, APA, and nearly 120 organizations representing physicians across the country expressed their strong support for proposed rules that would reform the prior authorization process for Medicare Advantage plans and Medicare Part D.In particular, the organizations expressed support for provisions that improve the coverage criteria for medical necessity determinations and protect access to care. Other provisions that the organizations support would protect patients from care interruptions, treatment delays, and unanticipated medical costs.“Recent [AMA] survey data show that 93 percent of physicians report care delays or disruptions associated with [prior authorization],” the letter stated. “AMA data also show that 34 percent of physicians report that [prior authorization] has led to a serious adverse event (e.g., hospitalization, permanent impairment, or even death) for a patient in their care. … Moreover, the Office of Inspector General 2022 report found that 13 percent of [prior authorization] requests denied by Medicare Advantage plans met Medicare coverage rules.”APA, AMA’s Letter to CMS on Prior Authorization APA Responds to CMS’s Request for Information on Essential Health BenefitsCMS recently released a request for information on essential health benefits (EHB) established under the Affordable Care Act. In its response, APA highlighted barriers that patients face to accessing mental and substance use disorder (SUD) services, the importance of telehealth in improving access to these EHB services, and the potential for the Collaborative Care Model to address gaps in coverage.APA noted administrative barriers such as prior authorization, workforce issues, and lack of parity. “Patients often experience a delay in accessing care due to the persistent shortage of psychiatrists and coverage across the country,” APA’s letter, addressed to Brooks-LaSure, stated. “As demand for their services increase, psychiatrists continue to meet capacity limitations.”Further, APA signed a coalition letter urging CMS to consider children’s needs when addressing EHBs. The letter emphasized that children require services and care specifically suited to their unique developmental needs.“Amid the children’s mental health emergency, there is a strong need to reduce the current gaps in coverage related to pediatric mental health services,” the coalition’s letter stated. “EHB requirements can play an important role in addressing these coverage gaps by incorporating coverage of pediatric mental health services in the ‘pediatric services’ category.” ■APA’s Letter on Mental Health and SUD EHBsThe Coalition’s Letter on EHBs for Children ISSUES NewArchived

Impact on COVID-19 Pandemic in Children’s Mental Health and Current Emergency Care – A Narrative Review

Coronavirus disease-2019 (COVID-19) has quickly spread worldwide, suffering countless people from its severe acute respiratory syndrome and lowering the economic status of almost every nation. A pivotal factor in determining the severity of the current pandemic situation in society was the emergence of the current pandemic, the risk factors associated with the mental state of children with COVID-19 infection, and the immunology and behavior of the children. The treatment of hypoxic children (oxygen saturation below 92%) and the elderly involves oxygen therapy; with the availability of facilities such as continuous positive airway pressure therapy, a nasal cannula with a high flow rate, or a ventilatory tube may be necessary for children and the adult population. Multisystem inflammatory syndrome in children, a newly identified COVID-19-related condition/disease, has also been identified and is now termed omicron.

Mental Health Diagnoses, Health Care Utilization, and Placement Stability on Antipsychotic Prescribing Among Foster Care Youth.

This study sought to examine how mental health diagnoses, health care utilization and foster care placement instability affect antipsychotic prescribing and how these factors may contribute to disproportionate antipsychotic prescribing among youth in foster care. This retrospective cohort study utilized EHR data that were linked to administrative child welfare data. Two outcome variables were analyzed: 1) any antipsychotic prescription documented and 2) number of antipsychotic prescriptions documented. Predictor variables included foster care status, number of unique mental health diagnoses, counts of health care encounters over the study period, and counts of foster care placements. Covariates included gender, persons of color, and age in years. Models were estimated using logistic regression for the dichotomous outcome and Poisson regression for the count outcome. Increased antipsychotic prescribing among children in foster care persists even after accounting for mental health diagnoses and health care utilization. However, the number of placements modified the effect of foster care involvement on antipsychotic prescribing such that after 2 placement changes, the odds of being prescribed an antipsychotic surpassed the effect of foster care involvement. More mental health diagnoses, more inpatient and emergency health care encounters, and more foster care placements were associated with an increased odds of being prescribed an antipsychotic and an increased count of antipsychotic prescriptions. Decreased primary care encounters were associated with increased odds of antipsychotic prescriptions, and decreased specialty encounters were associated with higher counts of antipsychotic prescriptions. Placement instability is associated with disproportionate antipsychotic prescribing among youth in foster care.

A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care

On July 16, 2022, the 988 mental health crisis hotline launched nationwide. In addition to preparing for an increase in call volume, many jurisdictions used the launch of 988 as an opportunity to examine their full continuum of emergency mental health care. Our goal was to understand the characteristics of jurisdictions’ existing continuums of care, identify factors that distinguished jurisdictions that were more- versus less-prepared for 988, and explore perceived strengths and limitations of the planning process. We conducted 15 qualitative interviews with state and local mental health program directors representing 10 states based on their preparedness for the 988 rollout. Interviews focused on 988 call centers, mobile crisis response, and crisis stabilization, as well as strengths and limitations of the 988 planning process. Data were analyzed using rapid qualitative analysis, an approach designed to draw insights on evolving processes and extract actionable findings. Interviewees from jurisdictions that reported that they were more-prepared for the launch of 988 tended to have local 988 call centers and already had local access to mobile crisis teams and crisis stabilization units. Interviewees across jurisdictions described challenges to offering a robust continuum of crisis services, including workforce shortages and geographic constraints. Though jurisdictions acknowledged the importance of integrating peer support staff and serving diverse populations, many perceived room for growth in these areas. Though 988 has launched, efforts to bolster the existing continuum will continue and hinge on efforts to expand the behavioral health workforce, engage diverse partners, and collect relevant data.

Young adults with eating disorders perspectives on educational resources to support the transition into adult medicine: a thematic analysis

BackgroundEating disorders (EDs) commonly develop in adolescence and can be a chronic condition. Once patients reach the age when it is no longer permitted or appropriate for them to be seen in a children’s healthcare setting, they will need to transition into adult-focused care. This transition period can be challenging, with increased risks of negative health outcomes and disruptions in care. Appropriate educational resources could be an effective support for patients during this transition. Our objectives were to engage patients about the value of developing educational supports and determine how these supports should be structured to be most useful to young adults with EDs.MethodsPatients who had transitioned out of a hospital-based ED program between 2017 and 2020 were invited to participate in a semi-structured interview. Data were analyzed using thematic analysis and qualitative description.ResultsSix young adults (5 females and 1 male) with EDs were interviewed. All participants thought it would be helpful to have an educational resource. Three main themes and seven subthemes were identified. Themes identified related to the unique challenges of transition for ED patients given the age of onset and cycle of symptoms; issues in adult care related to comorbidities and new level of autonomy; and the value of educational resources as both a connection tool and a benchmark. Participants also thought it would be useful to include in any educational resource a summary of their previous treatments, information regarding the transition process, a list of main healthcare providers they saw for their ED, a description of the differences and expectations of the adult system, a list of their follow up appointments, and a list of community and emergency mental health resources.ConclusionsParticipants said that educational supports can play a useful role for young adults with EDs during their transition into adult care. They also provided valuable insights into the desired contents of such supports and expanded on the roles that educational resources could serve for ED patients.

How to Reach a Mobile Crisis Team: Results From a National Survey.

Back to table of contents Previous article Next article DatapointsFull AccessHow to Reach a Mobile Crisis Team: Results From a National SurveyRachel Odes, Ph.D., R.N., Deepa Manjanatha, M.P.H., Preston Looper, M.S., L.P.C.-S., Megan McDaniel, B.A., Matthew L. Goldman, M.D., M.S.Rachel OdesSearch for more papers by this author, Ph.D., R.N., Deepa ManjanathaSearch for more papers by this author, M.P.H., Preston LooperSearch for more papers by this author, M.S., L.P.C.-S., Megan McDanielSearch for more papers by this author, B.A., Matthew L. GoldmanSearch for more papers by this author, M.D., M.S.Published Online:20 Mar 2023https://doi.org/10.1176/appi.ps.20220449AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The rollout of the 988 Suicide & Crisis Lifeline in July 2022 has raised urgent questions surrounding the infrastructure available to support callers during and after a call for help (1, 2). Currently, 988 callers are routed to their local National Suicide Prevention Lifeline (NSPL). From there, call-takers may provide counseling or initiate a referral. Should a caller urgently need in-person support, deployment of a mobile crisis team (MCT) would be a useful option (3). MCTs comprise behavioral health providers, medical staff, and sometimes law enforcement (in co-responder models) (4). MCTs are widely used, but a systematic description of their deployment and functioning is needed.Data Source and MethodsDuring 2021–2022, we conducted a survey of U.S. MCTs, defining an MCT broadly to include co-responder models, clinician-led teams, and teams including medical personnel. We recruited a convenience sample of participants who led or worked in an MCT through national Listservs, social media, and personal invitation. We asked participants about their program’s key features and then calculated descriptive statistics. After analysis of missing and duplicate data, we included 554 responses. Respondents could skip questions and respond anonymously.ResultsRespondents were in 45 states, and most described their roles as either MCT program director (N=237 of 501, 47%) or MCT clinician (N=105 of 501, 21%). Figure 1 depicts responses to the question of how respondents’ MCTs can be deployed. Of the 474 respondents who answered the question, nearly one-third (32%, N=154) reported that their MCTs could be deployed by calling the NSPL. The most commonly reported channel for reaching an MCT was to call teams directly (N=306, 65%), and the second most common was calling 911 (N=256, 54%).Figure 1. Phone number or agency that community members could call to deploy a mobile crisis team (MCT) in respondents’ programs (N=474)aaRespondents could choose more than one option.ImplicationsAlthough access to MCTs is an essential component of emergency mental health services, MCTs in many communities cannot be reached via 988. As federal and local agencies continue to implement 988-related changes, they should consider linking call centers to MCTs. The national 988 implementation sets the stage to establish a simplified point of access for mental health support and will hopefully streamline the process of connecting clients to services (5). As communities continue to integrate 988 calls into their service continuum, it should be recognized that current services are frequently fragmented and that it is important to communicate to community members how they can reach an MCT when needed.National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman).Send correspondence to Dr. Goldman ([email protected]). Tami L. Mark, Ph.D., and Alexander J. Cowell, Ph.D., are editors of this column.Dr. Goldman is a paid research consultant to the National Council for Mental Wellbeing, Peg's Foundation, the University of California, Davis, and the Research Foundation for Mental Hygiene, Inc. The other authors report no financial relationships with commercial interests.

'An accident waiting to happen' - experiences of police officers, paramedics, and mental health clinicians involved in 911-mental health crises: a cross-sectional survey.

Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under-prepared. The single frontline service approach is time-intensive and risks a coercive pathway to care. The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal. Police and ambulance staff struggled keeping up with the mental health demand, reporting inadequate mental health training, little enjoyment and negative experiences when trying to access help from other services. Most mental health staff had adequate mental health training and enjoyed their work, but many experienced difficulties getting help from other services. Police and ambulance staff found it hard to work with mental health services. The combination of limited training, poor interagency referral processes, and difficulties accessing support from mental health services means that when police and ambulance services attend mental health crises alone, distress may be heightened and prolonged. Enhanced mental health training for first responders and more streamlined referral processes may improve process and outcomes. Mental health nurses have key skills that could be utilized in assisting police and ambulance staff who attend 911 emergency mental health calls. New models such as co-response teams, whereby police, mental health clinicians and ambulance staff respond conjointly should be trialled and evaluated. INTRODUCTION: First responders are increasingly called to assist people experiencing mental health crises but little research exists canvassing multi-agency perspectives of such work. To understand the views of police officers, ambulance and mental health staff attending mental health or suicide-related crises in Aotearoa New Zealand and to discover how they experience current models of cross-agency collaboration. A descriptive cross-sectional survey involving mixed methods. Quantitative data were analysed using descriptive statistics and free text by content analysis. Participants included 57 police officers, 29 paramedics and 33 mental health professionals. Mental health staff felt adequately trained, but only 36% described good processes for accessing inter-agency support. Police and ambulance staff felt undertrained and unprepared. Accessing mental health expertise was considered difficult by 89% of police and 62% of ambulance staff. Frontline services struggle managing mental health-related 911 emergencies. Current models are not working well. Miscommunication, dissatisfaction and distrust exist between police, ambulance and mental health services. The single-agency frontline response may be detrimental to service users in crisis and under-utilizes the skills of mental health staff. New ways of inter-agency cooperation are required, such as co-located police, ambulance and mental health nurses responding in partnership.

Engaging emergency medical services to improve postacute management of behavioural health emergency calls: a protocol of a scoping literature review

IntroductionThe public health crisis of escalating mental health, behavioural and substance-related emergencies has revealed the need to approach these complex events from a health perspective, rather than the traditional criminal...

Applying the Surgical Checklist Approach for Psychiatric Trainees to a Busy, Time Sensitive Psychiatric Crisis Environment

IntroductionThe Jackson Hospital Crisis (Psychiatric ED) Center serves the entirety of Miami-Dade County in Florida and is considered one of the top three busiest and per capita of clinical staff likely the busiest nationally across the United States. Simultaneously, the management of mental health emergencies has ascended near the top of international priorities driven by multiple trends (e.g., growing social isolation associated with the pandemic, de-stigmatization). The crisis environment presents a uniquely difficult challenge in applying high quality medical care: frequent suicidal gestures, impulsive often intoxicated or psychotic patients, unprecedented demand, diminishing staff capacity, and requirements to consistently apply specific medical and psychiatric protocols. These challenges are specifically difficult for new trainees who are not yet accustoms to the high acuity situations found in psychiatry. Moreover, academic, institutional, and governmental policies change on a monthly, or even weekly basis, often with the objective of improving care. Nevertheless, such constant shifts in workflow result in opportunities for errors that impact patient trajectories.ObjectivesAs such we endeavored to apply an evidence-based approach to improving the likelihood of success. One such vetted approach, the use of checklists, benefits from 10+ years of peer-reviewed research in “operational” medical specialties (e.g., surgery, ED, ICU) where work is segmented around interventions or time-shifts which share commonalities with the Psychiatric ED model. Yet the difficulty in implementing such models is typically not in the “hard” aspects of defining the checklist, but in the “soft” implementation dimensions of syndication, distribution, and enablement in the context of the individual unique settings.MethodsWe developed a checklist that will be implemented on the Jackson Crisis emergency department, with the aim of having first year trainees complete the check list on each individual patient. Surveys were administered before implementation of checklist and will be distributed on a quarterly basis to trainees to evaluate for changes in resident confidence and clinical care.ResultsOver six months, we launched this initiative with drivers of adoption focused on accelerating and easing new resident training, safety incident targeting, and in the balancing of “push” top/down and “pull” bottom/up dynamics. Initial learnings include rapidly improving resident satisfaction as well as various other impacts currently being observed throughout the institution.ConclusionsOverall reception to the checklist has been positive from attendings and new trainees alike, further evidence will be analyzed and presented as the checklist is utilized throughout the psychiatric ED.Disclosure of InterestNone Declared

Ashley Judd to Speak at APA Annual Meeting

Back to table of contents Previous article Next article Annual MeetingFull AccessAshley Judd to Speak at APA Annual MeetingKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:25 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.66AbstractGolden Globe winner and Emmy-nominated actress Ashley Judd has long been a devoted activist and humanitarian, championing women’s rights and public health issues. She has also written about the need to ensure privacy for families following the death of a loved one to suicide.Actor and mental health advocate Ashley Judd is the keynote speaker at the Opening Session of APA’s 2023 Annual Meeting. The Opening Session will be held Saturday, May 20, at 5:30 p.m. in the Moscone Center.Known for her roles in “De-Lovely,” “Ruby in Paradise,” and “Double Jeopardy,” actress, writer, and humanitarian Ashley Judd, M.P.A., will be a plenary speaker at the 2023 APA Annual Meeting in San Francisco.Judd has also gained worldwide acclaim as an avid advocate of human rights, with a focus on gender equality and public health. Since 2004 she has worked with numerous NGOs and traveled the world in support of public health efforts related to maternal health, child survival, HIV prevention, and malaria prevention and treatment.She currently serves as a Global Goodwill Ambassador for the United Nations (UN) Population Fund, the UN’s sexual and reproductive health agency. She is also the chair of the Women’s Media Center Speech Project: Curbing Abuse, Expanding Freedom; a Global Ambassador for both Population Services International and Polaris Project; and a member of the leadership council of the International Center for Research on Women.Judd earned her master’s degree from Harvard’s Kennedy School of Government. In 2017, she was the recipient of the Muhammad Ali Kentucky Humanitarian Award. Her undergraduate alma mater, the University of Kentucky, established the Ashley T. Judd Distinguished Graduate Fellowship in the Office for Policy Studies on Violence Against Women.She was also featured on the cover of TIME Magazine’s 2017 Person of the Year issue, which honored the thousands of individuals across the world who spoke out about their experiences of sexual harassment and assault, dubbed “The Silence Breakers.”Judd has written about her family experiences with mental illness. In August 2022, she penned a guest essay in the New York Times about her family’s effort to keep police reports related to the suicide of her mother, Naomi Judd, private. Naomi Judd was a well-respected musician who dealt with mental illness for much of her life.Tennessee law allows police reports from closed investigations, including family interviews, to be made public. “Naomi lost a long battle against an unrelenting foe that in the end was too powerful to be defeated,” Ashley Judd wrote. “I could not help her. I can, however, do something about how she is remembered.”She wrote that she intends to make the invasion of privacy following an individual’s death by suicide “a personal as well as a legal cause.” She also called for a reformation of law enforcement procedures related to such cases. “Though I acknowledge the need for law enforcement to investigate a sudden violent death by suicide, there is absolutely no compelling public interest in the case of my mother to justify releasing the videos, images, and family interviews that were done in the course of that investigation.”Last August, Naomi Judd’s family filed for injunctive relief in Williamson County, Tenn., to keep the police records related to her death private. Last December, the Associated Press reported that the family had filed a notice to voluntarily dismiss the lawsuit, due in part to the fact that journalists who requested the police records were not requesting photographs or body cam footage. The notice also said a Tennessee state lawmaker is introducing legislation to make death investigation records private when the death is not the result of a crime.“I hope that leaders in Washington and in state capitals will provide some basic protections for those involved in the police response to mental health emergencies,” Ashley Judd wrote in her essay, adding that her mother “should be remembered for how she lived, which was with goofy humor, glory onstage, and unfailing kindness off it—not for the private details of how she suffered when she died.” ■ ISSUES NewArchived

Crowding in the Emergency Department: Challenges and Best Practices for the Care of Children.

Emergency department (ED) crowding has been and continues to be a national concern. ED crowding is defined as a situation in which the identified need for emergency services outstrips available resources in the ED. Crowding is associated with higher morbidity and mortality, delayed pain control, delayed time to administration of antibiotics, increased medical errors, and less-than-optimal health care. ED crowding impedes a hospital's ability to achieve national quality and patient safety goals, diminishes the effectiveness of the health care safety net, and limits the capacity of hospitals to respond to a disaster and/or sudden surge in disease. Both children and adults seeking care in emergency settings are placed at risk. Crowding negatively influences the experience for patients, families, and providers, and can impact employee turnover and well-being. No single factor is implicated in creating the issue of crowding, but elements that influence crowding can be divided into those that affect input (prehospital and outpatient care), throughput (ED), and output (hospital and outpatient care). The degree of ED crowding is difficult to quantify but has been linked to markers such as hours on ambulance diversion, hours of inpatient boarding in the emergency setting, increasing wait times, and patients who leave without being seen. A number of organizations, including the American College of Emergency Physicians, the Emergency Nurses Association, and the National Quality Forum, have convened to better define emergency metrics and definitions that help provide data for benchmarks for patient throughput performance. The Joint Commission has acknowledged that patient safety is tied to patient throughput and has developed guidance for hospitals to ensure that hospital leadership engages in the process of safe egress of the patient out of the ED and, most recently, to address efficient disposition of patients with mental health emergencies. It is important that the American Academy of Pediatrics acknowledges the potential impact on access to optimal emergency care for children in the face of ED crowding and helps guide health policy decision-makers toward effective solutions that promote the medical home and timely access to emergency care.

Follow-up After Pediatric Mental Health Emergency Visits.

To examine how outpatient mental health (MH) follow-up after a pediatric MH emergency department (ED) discharge varies by patient characteristics and to evaluate the association between timely follow-up and return encounters. We conducted a retrospective study of 28 551 children aged 6 to 17 years with MH ED discharges from January 2018 to June 2019, using the IBM Watson MarketScan Medicaid database. Odds of nonemergent outpatient follow-up, adjusted for sociodemographic and clinical characteristics, were estimated using logistic regression. Cox proportional hazard models were used to evaluate the association between timely follow-up and risk of return MH acute care encounters (ED visits and hospitalizations). Following MH ED discharge, 31.2% and 55.8% of children had an outpatient MH visit within 7 and 30 days, respectively. The return rate was 26.5% within 6 months. Compared with children with no past-year outpatient MH visits, those with ≥14 past-year MH visits had 9.53 odds of accessing follow-up care within 30 days (95% confidence interval [CI], 8.75-10.38). Timely follow-up within 30 days was associated with a 26% decreased risk of return within 5 days of the index ED discharge (hazard ratio, 0.74; 95% CI, 0.63-0.91), followed by an increased risk of return thereafter. Connection to outpatient care within 7 and 30 days of a MH ED discharge remains poor, and children without prior MH outpatient care are at highest risk for poor access to care. Interventions to link to outpatient MH care should prioritize follow-up within 5 days of an MH ED discharge.

Notifying university students' emergency contacts in mental health emergencies: Multi-year analysis of student consent policy preferences

Information sharing is a frequently discussed yet divisive suicide prevention strategy in universities. This study aimed to investigate which students are most and least likely to opt-in to university permission to notify an emergency contact if there are serious concerns about their mental health. Routine cross-sectional data were obtained from 29,799 students in 2020 and 31,998 students in 2021 within a UK university. The proportion of students opting-in to a ‘consent to contact policy’ across years was summarised descriptively. Multiple logistic regression models examined the odds of students opting-in dependent on student characteristics (probable clinical depression, age, gender identity, sexuality, ethnicity, home/international student status, disability, study mode and level of study). Most students opted-in to the policy in 2020 (91.2%, n = 27,146) and 2021 (90.4%, n = 28,912). Probable clinical depression (OR = 0.63, 95% CI = 0.54 to 0.72) and gender identity different from sex (OR = 0.63, 95% CI = 0.44 to 0.90) had the strongest associations with not opting-in in 2020. Identifying as male, lesbian/gay/bisexual, Asian ethnicity, declaring a disability, and being a taught postgraduate student were also predictive of not opting-in. These results were replicated in the 2021 dataset. Some of the most vulnerable students appear least likely to opt-in. Insights are offered about potential gaps in universities' access to emergency contacts to prevent serious harm or loss of life. Further research is required into why the groups identified in this study are less likely to opt-in and what additional support they may require.

Design, development and randomised controlled trial protocol of a smartphone-delivered version of ‘SOLAR’ for emergency service workers to manage stress and trauma

IntroductionEmergency service workers are routinely exposed to stress and trauma, and there is a need to address mental health symptoms early to prevent chronic impairment and/or psychiatric disorder. Digital health...