Emergency psychiatric consultation in the community

The provision of a telephone hotline for children, adolescents, and carers—manned by experienced staff who are able to assess the emergency—is essential. High suicidal risk and suicidal attempts should be seen the same day. On-site assessment may be required, including police assistance, and consultation with the general practitioner and other social services may be required. Overall, a systems approach should be used.

Health workers in the community facing an emergency situation will require prompt assistance and support from a mental health service. Children taken into care in an acute situation and who present with severe behavioural or emotional problems are best assessed in their own setting, rather than in the clinic. Discussion with the staff in the residential service is essential since diagnostic issues may arise, especially in relation to attention-deficit hyperactivity disorder, post-traumatic stress disorder, depression, and psychotic illness.

Many children with serious mental health problems are seen by general practitioners. Child and adolescent psychiatrists can help the general practitioner by providing an emergency telephone consultation service, which is especially useful for discussing medication and its possible side-effects. With assistance, the general practitioner may be able to manage the crisis, thus avoiding an emergency presentation at the hospital.

Available emergency mental health services are limited in countries with large rural areas. Therefore, the development of video conferencing is an effective way of providing diagnostic and treatment consultations, and may enable emergency situations to be contained and managed without the additional stress of long-distance travel.

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