Key points are not available for this paper at this time.
Objectives Young people in the UK have a higher mental health need than ever before, with CYP (Children and Young People) seeing a significant increase in anxiety and depression year on year since the COVID-19 pandemic.1 Acute presentations to hospital services continue to increase, with an ongoing lack of adequate and appropriate provision to meet this demand.2 Individually we have little control over this, however as Paediatricians we have a duty to support our patients as best we can and ensure each encounter counts. Simply starting a conversation around mental health and signposting to useful resources can have important benefits,3 with well documented tools for this within Paediatrics and Emergency Medicine, such as HEEADSSS.4 Moreover, the RCPCH Facing the Future of Emergency Care plan outlines the need for all CYP presenting to a Children's Emergency Department to have a developmentally appropriate assessment of their immediate emotional and mental health needs.5 Methods A retrospective case review of all CYP with mental health presentations referred to Paediatrics at a busy District General Hospital was conducted over a 12 month period. We assessed whether an appropriate psychosocial assessment was performed and if the HEEADSSS assessment tool had been implemented. Both qualitative and quantitative questionnaires were then conducted to gauge both clinician's familiarity and confidence in undertaking these assessments, as well as exploring perceived barriers to their use. Teaching resources and a dedicated proforma were then introduced, alongside education in signposting young people to appropriate resources. Results Our results showed that 57% of CYP had a limited assessment of their psychosocial wellbeing on admission, with only 5.5% having a full HEEADSSS assessment performed. 80% of presentations were subsequently reviewed by CAMHS. 70% of staff were aware of assessment strategies and felt they were useful for their practice, although only 35% were familiar with their use. Moreover, only 17% felt confident approaching these questions with CYP, with the majority of staff only asking them occasionally. Time pressures, lack of appropriate space and training in approaching these conversations were listed as potential barriers. Conclusion This project highlights the reduced confidence and familiarity clinicians show in undertaking psychosocial assessments in CYP, resulting in missed opportunities and poor compliance with national standards. With the increasing prevalence of unmet mental health needs it is imperative that staff feel confident in exploring these issues with children and this project describes clear barriers experienced in providing this care. References https://www.mind.org.uk/about-us/our-strategy/doing-more-for-young-people/facts-and-figures-about-young-people-and-mental-health/. https://www.rcpch.ac.uk/news-events/news/time-raise-standard-children-presenting-emergency-departments-mental-health-crisis. Alrisi K, Alnasif N, Nazeer A, et al. Archives of Disease in Childhood Published Online First, Risk of suicide in children and adolescents in the emergency department—is universal screening the answer?, 16 March 2023. doi: 10.1136/archdischild-2022-325122 https://dontforgetthebubbles.com/using-your-heads-ed/. Royal College of Paediatrics and Child Health, Facing the Future: Standards for Children in Emergency Care settings, 2018.
Harris et al. (Tue,) studied this question.