Background:Emergency departments are critical care settings for children in mental and behavioral health crises. Psychiatrists and psychiatric-mental health nurses collaborate with emergency department teams to manage safety risks for these patients, which often involves constant patient observation, particularly for agitated or suicidal patients. Objective:This paper aims to understand emergency department staff's perspectives on constant observation of pediatric mental and behavioral health patients and the impact of this practice on emergency department workflows. Methods:This qualitative study thematically analyzes 55 semi-structured interviews with members of the emergency department team, including patient observers, from four different hospitals. Results:Eight themes were identified as impacting emergency department workflows and patient care. The most commonly mentioned themes included the impact of constant observation on emergency department workflow, situational awareness and clear sightlines to the patient, and compliance with constant observation-related organizational policies. Conclusions:Findings provide insights for optimizing the role of the patient observer, incorporating remote monitoring to increase patient safety, enhancing the emergency department physical environment to enhance the quality of care, optimizing patient outcomes, and maintaining a safe environment. This study's results support advanced psychiatric-mental health practice nurses and emergency and psychiatric-mental health clinical nurses in improving the quality of care and safety for this vulnerable population.
The objective of this study is to investigate the prevalence of amphetamine use and cigarette smoking and their relationships with suicidal behaviors (thoughts, plans, and attempts) among adolescents in Liberia. The analysis included 2744 school-going adolescents who participated in Liberia’s 2017 Global School-based Student Health Survey (GSHS). The study used descriptive statistics to evaluate prevalence estimates, and multivariable logistic regression was employed to determine how amphetamine use and cigarette smoking predict suicide behaviors. Prevalence of amphetamine use and cigarette smoking was 7.7% and 9.9%, respectively. In multivariable logistic regression, amphetamine use and cigarette smoking independently increase the odds of suicide behaviors (suicide ideation, suicide plan, and suicide attempt) after controlling for other factors. High prevalent rates of substance use and their association with suicidal behaviors reported in this study highlight the need for these countries to target appropriate substance use interventions to curb the rates of suicide among adolescents.
The increase in mental health crises and the need for a comprehensive, cost-effective response have posed challenges to the public health system. The emphasis on providing services in a “safe environment” has enforced the notion that hospitals are most secure for the individual in crisis. This paper describes an alternative to hospital-based mental health crisis services based on the principles of trauma-informed care. The outcomes of this alternative model are also outlined.
Treatment-resistant schizophrenia can create a high disease burden for some patients, making it challenging for all involved to navigate a good outcome. Such cases require physicians to regard symptom eradication and treatment success as the same. This commentary on a case considers a palliative psychiatry approach grounded in the well-being of patients and inclusion of all stakeholders in decision-making processes.
