The management of child and adolescent psychiatric emergencies 

This chapter provides a practical approach to the management of psychiatric emergencies in children and adolescents. Such emergencies are challenging for a number of reasons. The professional resources available are usually very limited, and there is often confusion or even disagreement between professionals over what constitutes a psychiatric, as opposed to a social emergency. The parents or carers play a key role in the situation and need to be engaged and involved appropriately in the assessment and management; and issues of confidentiality and consent need to be taken into account. In addition, the psychiatrist may find himself or herself working in a variety of settings—the child's home, a hospital emergency department (A and E), a police station, a children's home, or residential school—where the facilities for assessing an angry, disturbed, or upset child may be far from ideal. Most emergencies occurring in community settings involve externalizing behaviours: aggression, violence; deliberate self-harm, or threats of harm to self or others; or extreme emotional outbursts. Some will involve bizarre behaviour which could be an indication of serious mental illness or intoxication by drugs or alcohol, or a combination of both. The emergency situation often arises in the context of acute family conflict or distress. Frequently other agencies are involved before the psychiatrist is called in (for example, emergency room staff, social workers, or the police). The on-call psychiatrist needs to be familiar with or able to obtain immediate advice about his or her local child and adolescent psychiatric services, the local child protection and child care procedures, and with the relevant mental health and child care legislation. Vignette 1: