Top 2023 Patient Safety Concerns: The Pediatric Mental Health Crisis

By Tammie Smeltz

Each year, ECRI and their affiliate, the Institute for Safe Medication Practices (ISMP), release their annual report, “Top 10 Patient Safety Concerns“. The report identifies serious issues that threaten the safety of patients and healthcare workers when processes and systems are not in alignment. The report provides recommendations to address these concerns and is grounded on the following four interdependent foundations provided by the National Steering Committee for Patient Safety:

  • Culture, Leadership and Governance
  • Patient and Family Engagement
  • Workforce Safety
  • Learning System

The pediatric mental health crisis is ECRI’s top concern for patient safety in 2023. Prior to the pandemic, the rates of depression and anxiety rose in children due to the increased use of social media, gun violence, alcohol, drugs and socioeconomic factors. Rates of anxiety and depression in children ages 3 to 17 rose 29% and 27% respectively in 2020 compared to 2016 according to a study published in JAMA Pediatrics. While anxiety and depression are on the rise in children regardless of gender, the CDC reported that teenage girls are experiencing a record high level of violence, sadness and suicide risk.

Emergency room visits are on the rise, as well. Studies have shown that while the emergency department can stabilize a child in crisis, follow-up is key. Unfortunately, due to factors such as lack of access to psychiatric care, children often wind up back in the emergency department, or in some instances, remain in the ED for extended periods of time, waiting for appropriate resources to become available.

A study published recently in the journal Pediatrics followed over 28,000 children ages 6 to 17 who had at least one emergency department visit between January 2018 and June 2019. All the children were Medicaid recipients. The study found that less than one-third of the children had a follow-up mental health visit within seven days of discharge and that only slightly more than 55% had a follow-up visit within one month. According to the study, follow-up mental health visits decrease a child’s risk for suicide, increase medication adherence and decrease the risk for additional emergency department visits. The study also revealed that without appropriate follow-up care, more than a quarter of the children returned to the emergency department within six months.

Prior to the 2023 ECRI report, MLMIC identified the pediatric mental health crisis as a critical concern for our insureds and their patients. MLMIC has developed and shared several risk management strategies to address this issue. The following are a few procedures to implement when taking care of a minor with mental health issues:

  • Conduct an appropriate and thorough assessment. It is important to understand the patient’s complaints and concerns, as well as their past medical history, including their family history. The practitioner should always be alert to potential high-risk diagnoses and keep an accurate, up-to-date list of concerns.
  • Always convey and coordinate clear communication. It is imperative to provide thorough and clear instructions to the patient and their family. When speaking with patients and families, determine whether there are health literacy or other comprehension barriers. It is also important to set expectations with the patients and families, especially where behavioral health resources are limited. If other medical specialties participate in care, the practitioners should discuss next steps and determine who is responsible for the patient. This should all be documented in the medical record.
  • Documentation must be accurate, detailed and timely. The practitioner should describe the rationale for the inclusion/exclusion of each differential diagnosis. It is crucial to timely document thorough, objective information about the results of patient assessments and education of the patient/family about treatment plans. This should include medication regimens and any history of nonadherence.
  • Ensure your office has the appropriate policies and procedures in place. The office practice should have policies and procedures in place that include emergency plans such as de-escalation techniques. MLMIC recommends having a process in place for tracking and follow-up on diagnostic testing, consultations/referrals, appointment setting and managing patient nonadherence.

Additionally, practitioners must be mindful of informed consent when treating a minor. The consenting party must have “parental responsibility” and in many circumstances, this is not a biological parent. A minor can consent to care when receiving confidential treatment in situations, such as reproductive health care, post-sexual assault care and emergency medical care.

As we continue to navigate our way through the pediatric mental health crisis, MLMIC Insurance Company offers a variety of educational programs on this topic, as well as risk management advice on topics such as implementing policies and procedures, vaccination compliance, informed consent, guardianship and more.

MLMIC policyholders can reach our 24/7 emergency support services by calling (844) MMS-LAW1. You can also submit a specific question by sending an email request here.

Tammie Smeltz is the Content Marketing Manager at MLMIC Insurance Company.

Photo by Zhivko Minkov on Unsplash