Service delivery

The emergency room of a local hospital is the traditional entry point for children and adolescents in mental health crises. The waiting time may be long and they may have to see a number of professionals before being assessed by a mental health professional. Providing a more accessible and flexible response to emergency care should be a priority in service development.

A youth emergency service comprising six components has been described by Shulman and Athey; (!2) this is an example of how different services can be co-ordinated to provide help for young people presenting in emergency or crisis.

1. A team of child crisis specialists screen and evaluate all incoming referrals and triage the family to the outpatient services—sometimes providing immediate clinical crisis intervention and short-term treatment if indicated.

2. A mobile crisis team is on call 24 h a day to assess and manage the child's problem on-site—and to stabilize the crisis and ensure the child's physical and emotional safety.

3. A telephone consultation service is available for mental health professionals to reach child and adolescent psychiatrists to discuss alternative treatment models or medication.

4. A crisis intervention team provides intensive treatment in the family home.

5. A residential crisis service allows for short-term out-of-home placement when safety and intensive care are needed.

6. Finally, more intensive inpatient management may be needed, especially for older children and adolescents.

The above model describes the integration of different ideas, including urgent and ongoing, clinic and outreach, outpatient and inpatient, and direct and consultation services. The fundamental principle is to consider an emergency service as part of a package of mental health service provision.

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