Involuntary Psychiatric Holds in Preadolescent Children
Abstract
Introduction: Little is known about the use of involuntary psychiatric holds in preadolescentchildren. The primary objective was to characterize patients under the age of 10 years on involuntarypsychiatric holds.
Methods: This was a two-year retrospective study from April 2013 – April 2015 in one urbanpediatric emergency department (ED). Subjects were all children under the age of 10 years whowere on an involuntary psychiatric hold at any point during their ED visit. We collected demographicdata including age, gender, ethnicity and details about living situation, child protective servicesinvolvement and prior mental health treatment, as well as ED disposition.
Results: There were 308 visits by 265 patients in a two-year period. Ninety percent of involuntarypsychiatric holds were initiated in the prehospital setting. The following were common characteristics:male (75%), in custody of child protective services (23%), child protective services involvement(42%), and a prior psychiatric hospitalization (32%). Fifty-six percent of visits resulted in dischargefrom the ED, 42% in transfer to a psychiatric hospital and 1% in admission to the pediatric medicalward. Median length of stay was 4.7 hours for discharged patients and 11.7 hours for patientstransferred to psychiatric hospitals.
Conclusion: To our knowledge, this study presents the first characterization of preadolescentchildren on involuntary psychiatric holds. Ideally, mental health screening and services could beinitiated in children with similar high-risk characteristics before escalation results in placement ofan involuntary psychiatric hold. Furthermore, given that many patients were discharged from theED, the current pattern of utilization of involuntary psychiatric holds in young children should bereconsidered.