Taking my child to A+E with a mental health crisis – what to expect
Attending A+E can be a distressing experience, especially if you are a young person suffering from a mental health crisis. A mental health crisis can include suicidal thoughts, self-harm, severe anxiety, delusional beliefs or a difficulty coping with your mental health at home. Here is a typical timeline of events to help you and your child understand and cope with the process.
Booking in and triage
After entering the department you will first meet the receptionist to ‘book in’. Soon after, the triage nurse will speak to you and direct you to the correct part of the department. This may be Paediatric A+E, Adult A+E or Resuscitation (‘Resus’) depending on your child’s age and the level of care and monitoring they require.
You will be able to stay with your child throughout the process; however you may be asked to leave the room briefly. This is so that the team can ensure your child is able to speak freely and confidently; without fear that they may upset or impact the relationship with their parent/guardian when discussing sensitive information.
Physical health assessment
This will only be required if there is an injury, signs of physical illness or if your child has self-harmed or taken an overdose. During this stage a doctor from the A+E team will review the young person, order investigations (which may include blood tests or x-rays) and consider treatments for their physical health.
Mental health assessment
This assessment may not occur immediately. Dependent on the hospital, it may be protocol for the mental health team to see a young person only after they have been assessed by the medical (i.e. physical) team, blood results have returned and treatment has been initiated. This can be a stressful wait and in some cases can take several hours.
Please be reassured that the A+E team have often already informed the Mental Health Team (MHT) about your child early on; and plans are in place to review them once results have returned. In some hospitals, this step may occur more quickly with ‘parallel assessments’ – where the A+E team and MHT will conduct their assessments in tandem.
During the assessment a mental health doctor or specialist Child and Adolescent Mental Health Nurse will speak with your child and yourself. This will usually last between 20 minutes and 90 minutes and will include assessing their mental state, asking about the events that have led to coming to A+E, your social circumstances and a risk assessment. This risk assessment will review the risk that your child may end their life, hurt themselves, harm others; and also evaluate whether they may be vulnerable to being harmed or abused by others.
Some of the questions cover sensitive topics and can be difficult to answer whilst you are in the room together. A mental health professional will often speak to each of you individually to paint a more thorough and accurate picture of the presentation to A+E. Then each party can speak freely without fear that they may upset their loved one.
What happens next?
Following assessment there are several options moving forward, these are dependent on the risk that harm may come to your child, their home situation and their current mental state.
Possible next steps after assessment include:
- Return home – if your child is deemed to be safe to return home. You may be able to leave the department soon after the assessment.
- Note. Before leaving, medications are reviewed and coping strategies may be put in place. This will include discussions on safety planning – such as asking you to move sharps and medications out of reach from your child. Alternatives to self-harm may be highlighted, such as holding ice or snapping elastic bands onto the site of previous cutting; creating a crisis plan of what to do when feeling distressed – and giving contact information including phone numbers of who to contact when needed.
- Staying in A+E – if after the first assessment it is still felt that your child may not be able to cope at home or is at too high risk to immediately return, you both may be asked to stay in A+E for further assessment over the next few hours to few days. This time frame can aid as a ‘cooling off period’ whereby ongoing assessment, reassurance and care planning can take place; in order to reduce the risks to your child whilst preventing a longer hospital admission.
- Admission to a mental health hospital – if the team have severe concerns about your child and believe they may need a more prolonged period of assessment and treatment, admission to a mental health hospital may be considered. This is rare, but can be a vital and necessary option in a small number of cases. If admission is planned, a bed will need to be found in a local children’s mental health hospital. This can occasionally take days due to the shortage of beds, so you may be asked to stay in A+E or be moved to the Paediatric ward before transfer. Your child will be regularly reviewed by the mental health team throughout this time.
What can I do to make the stay more comfortable for my child?
Although A+E can be an unpleasant place whilst in a mental health crisis, there are a number of things you can do to try to make this stay more comfortable.
- Speak to your nurse or doctor to stay informed about the current plan, next steps and waiting times
- Contact a friend or relative to bring in food, books, tablets or other entertainment to pass the time
- Ask for things like sandwiches, drinks or blankets (although they may not be the best quality – these are often things that can be supplied in A+E)
- If trying to sleep ask for lights or machinery in your cubicle to be turned off/silenced to aid a sense of calm
- If asked to stay overnight you can ask to be moved to the paediatric admissions ward (this will depend on space available and the results of the risk assessment). This can be particularly helpful for those with autism or sensory processing difficulties who struggle to cope with the unpredictability, loud noises and bright lights of A+E.
Summary
We have described taking a child to A+E with a mental health crisis – and what to expect. Attending A+E with your child can be a difficult and distressing event. We hope that the above timeline will help you to understand and cope better with the process.
