Unfair and Unequal: Comparing the Experiences and Outcomes of Children with Acute Mental Health and Acute Physical Health Presentations to the Paediatric Emergency Department

ABSTRACT

Aims A recent RCPCH publication shared the struggles across Paediatric Emergency Departments (PEDs) with meeting the 'Facing the Future' standards for children and young people (CYP) with mental health (MH) concerns, with few units studied being able to adequately meet the needs of CYP in MH crisis (1). We work in a central London teaching hospital and major trauma centre our aim was to understand the experience of CYP aged 13-17 presenting to the PED with MH concerns, as compared with those presenting with physical complaints. Methods Collection of quantitative data surrounding CYP in the ED with MH presentations (n=271), including time to be seen, time to see Child and Adolescent Mental Health Services (CAMHS), time to admission or discharge, and total time spent in ED (all as compared with physical health presentations n=7551). Use of independent samples t-tests to analyse differences between groups across outcomes. Two time periods (1 July-30 Oct 2019 and 1 July-30 Oct 2021, n= 3913 and 3909 respectively) were examined to encapsulate pre and post COVID. Qualitative inquiry with 22 CYP presenting to the ED to co-produce experience maps to visualise their healthcare journeys and identify opportunities to improve their care. Results CYP with MH presentations spent a mean time of 747.6 minutes in the ED, compared with physical health patients who spent 195.76 minutes (p=<0.001). Mean time to be seen by CAMHS was 225.0 minutes, whereas patients with physical health complaints who are referred to specialties waited 196.52 minutes to be seen (a difference that was not significant). More CYP with MH presentations than those with physical health presentations spent >4 hours but <12 hours in the ED (76.4% vs 18.4%, p<0.001) and almost 1/3 spent more than 12 hours in the ED (32.8% vs 1.0%, p<0.001). Experience mapping captured that CYP and families acknowledged the wait but would benefit from signposting of the physical environment (e.g. 'you are here' maps), the presence of age-appropriate entertainment, and the input of volunteers or staff to support basic needs (e.g. food, water, pillows) we are implementing each. Conclusion CYP with MH presentations have a worse experience of the ED than their counterparts with physical health complaints, spending longer in the department, being more likely to surpass 4 or 12 hours in the ED. CYP have indicated to us some simple changes to their environment and the management of their stay which could improve their experience. It is widely acknowledged that most areas need to grow our provision of CAMHS to meet the need, but we also need to further utilise other MH services available beyond hospital walls (e.g. crisis lines, wellbeing practitioners, school counselling, youth support services). (1) John Criddle, Virginia Davies, RCPCH Website https// www.rcpch.ac.uk/news-events/news/time-raise-standard-childrenpresenting- emergency-departments-mental-health-crisis.