Emergency department handbook: children and adolescents with mental health problems

210 Pages·2009·1.26 MB·English

by  Tony Kaplan

This practical handbook covers everything a practitioner needs to T
o
know about dealing with children and adolescents who present n
y
in an emergency department with mental health problems. It
K EmErgEnCy
provides an easily accessible framework of knowledge on child a �
p
and adolescent mental health, with comprehensive, easy-to- l
a
follow guidance. n dEparTmEnT HandbooK

The book includes contributions from professionals across a
range of disciplines: paediatrics, child and adolescent psychiatry,

liaison psychiatry, emergency medicine, and social care. The
authors clarify the roles and responsibilities of every professional
involved in the care of young patients and their families in a

very vulnerable and potentially frightening situation. The book E Children and adolescents
m
is intended for psychiatrists at all levels dealing with young e
people, paediatricians and emergency department clinicians, rg with mental health problems
e
teachers and trainers, and the heads of department, managers n
c
and commissioners who work together to provide effective and y

efficient services to meet the needs of this under-served client d
group. The subjects covered include: e
p
a
• understanding child and adolescent mental health problems r
t
m
• their social and developmental contexts
e
• the management of common mental health problems in this n
t
age group
H
• carrying out balanced risk assessments a
n
• liaison with social services and the role of other agencies
d
• the legal context b
o
• confidentiality and child protection o
k
• diversity issues.
About the editor
Tony Kaplan is a Consultant Child and adolescent psychiatrist at the
young people’s Crisis recovery Unit, north London, and was Chair of
the royal College of psychiatrists’ working group on CamHS in the
emergency department.

Tony Kaplan
Edited by
PUBLICATIONS
This page has been left
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Emergency Department
Handbook
Children and adolescents
with mental health problems
This page has been left
blank intentionally
Emergency Department
Handbook
Children and adolescents
with mental health problems
Edited by Tony Kaplan
RCPsych Publications
© The Royal College of Psychiatrists 2009
RCPsych Publications is an imprint of the Royal College of Psychiatrists,
17 Belgrave Square, London SW1X 8PG
http://www.rcpsych.ac.uk
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without permission
in writing from the publishers.
British Library Cataloguing-in-Publication Data.
A catalogue record for this book is available from the British Library.
ISBN 978 1 901671 73 2
Distributed in North America by Publishers Storage and Shipping Company.
The views presented in this book do not necessarily reflect those of the Royal College of
Psychiatrists, and the publishers are not responsible for any error of omission or fact.
The Royal College of Psychiatrists is a charity registered in England and Wales (228636) and in
Scotland (SC038369).
Printed by Bell & Bain Limited, Glasgow, UK.
Contents
Acknowledgements vii
Contributors viii
Abbreviations x
List of tables, boxes and figures xi
1 Introduction 1
Tony Kaplan
2 Contextual factors in assessing children and adolescents 10
Helen Bruce
3 Emergency assessment and crisis intervention 19
Tony Kaplan
4 Child and adolescent mental health presentations in the 33
emergency department
Josie Brown
5 Self-harm: issues, assessment and interventions 63
Tony Kaplan
6 Violence and extreme behaviour 76
Lois Colling and Eric Taylor
7 Consent, capacity and mental health legislation 86
Mary Mitchell
8 Child abuse and child protection 98
Tricia Brennan
9 Cultural diversity and mental health problems 107
Begum Maitra
10 Special considerations 115
Tony Kaplan
11 Confidentiality and information sharing 121
Tony Kaplan and Tricia Brennan
12 Practitioners and pathways: a competency framework 126
Tony Kaplan, Paul Gill, Diana Hulbert, Avril Washington,
Ian Maconochie and Annie Souter
v
contents
13 Issues for department heads and managers 144
Tony Kaplan
References 159
Appendix I Recommendations of the Joint Colleges Working 162
Group on CAMHS in the emergency department
Tony Kaplan
Appendix II Mental state examination checklist 169
Tony Kaplan
Appendix III Mental Health Act 2007: brief guide 172
Appendix IV Ten essential shared competencies for mental health 175
practice
Appendix V Protocols 177
Appendix VI Emergency department mental health risk 185
assessment tool
Diana Hulbert
Index 187
vi
Acknowledgements
This book is derived from the work of an inter-collegiate group that met under
the auspices of the Child and Adolescent Faculty Executive of the Royal College
of Psychiatrists, chaired by Dr Tony Kaplan, to examine the delivery of child and
adolescent mental health services in the setting of emergency departments in
the UK. We took reference from existing Royal College of Psychiatrists’ Council
Reports CR64, CR118 and CR122. This culminated in the Faculty document
Child and Adolescent Mental Health Problems in the Emergency Department and the
Services to Deal with These (Royal College of Psychiatrists, 2006a). Members of
the Working Group were: Josie Brown, Lois Colling, Tony Kaplan, Catherine
Lavelle, Helen Stuart and Julie Waine (all Royal College of Psychiatrists, Child
and Adolescent Faculty); Ian Maconochie and Avril Washington (Royal College
of Paediatrics and Child Health); and Diana Hulbert (College of Emergency
Medicine/British Association of Emergency Medicine).
I am very grateful to Dr Tricia Brennan for the trouble she took in proof-
reading the final draft of this book, Dr Sebastian Kraemer for his enduring
commitment, Dr Peter Bruggen for being the inspiration behind Chapter
3, and Drs Susannah Fairweather and Quentin Spender for their astute
editorial comments.
Special thanks
The chapter authors are especially grateful for contributions from the
following: Chapter 2, Tony Kaplan for the subsection on the importance of
attachment; Chapter 4, Lois Colling for the subsection on anxiety, Diana
Hulbert for the subsection on altered consciousness/altered mental status,
Tony Kaplan for the subsections on acute stress reactions and post-traumatic
stress disorder, and psychosis, and Catherine Lavelle for the subsections on
the side-effects of psychotropic medication and factors increasing index
of concern in substance misuse; Chapter 5, Quentin Spender for the
Differential Grid for Cutting; and Chapter 13, Catherine Lavelle for the
subsection on the paediatric liaison CAMHS team.
All specific references to the Scottish administrative and legal systems
were contributed by Dr Michael van Beinum.
vii
Contributors

Tricia Brennan, MBChB, DCH, FRCP, FRCPCH, FCEM, is Consultant
Paediatrician and Named Doctor for Child Protection for the Sheffield
Children's NHS Foundation Trust, and Designated Doctor for Child
Protection for Sheffield.
Josie Brown, MBChB, DRCOG, MRCPsych, is Consultant Child and
Adolescent Psychiatrist, Southampton General Hospital.
Helen Bruce, FRCPsych, is Consultant Child and Adolescent Psychiatrist,
East London NHS Foundation Trust, and Honorary Senior Clinical
Lecturer, Barts and the London School of Medicine and Dentistry.
Lois Colling, BSc, MRCPsych, Islington Primary Care Trust, London.
Paul Gill, MBBS, MRCPsych, is Consultant in Liaison Psychiatry, Sheffield
Health and Social Care NHSFT, The Longley Centre, Sheffield.
Diana Hulbert, BSc, MBBS, FRCS (Glas.), FCEM, is Emergency Medicine
Consultant, Department of Emergency Medicine, Southampton University
Hospitals NHS Trust
Tony Kaplan, MBChB, FRCPsych, Cert. Adv. Family Therapy (Sheldon
Fellow), Dip. Clin. Hypnosis (UCL), is Consultant Child and Adolescent
Psychiatrist at the New Beginning Young People’s Crisis Recovery Unit,
North London, part of the Barnet, Enfield and Haringey Mental Health
Trust.
Ian Maconochie, FRCPCH, FCEM, FRCPI, PhD, is Consultant Paediatrician
in the Paediatric Emergency Department, Imperial Academic Health
Sciences Centre, London.
Begum Maitra, MBBS, DPM, MRCPsych, MD (Psychiatry), is Consultant
Child and Adolescent Psychiatrist, and Jungian Analyst in the East
London NHS Foundation Trust (City and Hackney).
Mary Mitchell, MA, BM, MRCPsych, is Consultant Child and Adolescent
Psychiatrist, Leigh House Hospital, Winchester, part of the Hampshire
Partnership NHS Trust.
Annie Souter, CQSW Social Work, Dip. Social Work, Dip. Family Support
and Child Protection, is Team Manager, Children’s Social Care, Islington
Children’s Services, Whittington Hospital, London.
viii