Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=200825
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Most self-harming teens leave ERs without receiving mental health assessments

by ALEX GALLUCCI
Feb 21, 2012


SELF-HARM

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Most adolescents who go to the emergency room don't receive a mental health assessment before leaving, according to new research.

Only 39 percent of adolescents who head to the emergency room with self-harm injuries receive a mental health assessment before being discharged, according to a recent study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

But mental health professionals such as clinical psychologist David Castro-Blanco, a professor at the Adler School of Professional Psychology in Chicago, said these results are not surprising. “It’s a pretty clear call that things need to be different and changes need to be made,” Castro-Blanco said. “This is a population that is very likely to have repeat episodes that will land them back in the ER,” he said.



The term “self-harm” is defined as a self-inflicted injury that is made with either suicidal or non-suicidal intention. Mark Reinecke, a professor in the department of psychiatry and behavioral science at Northwestern University's Feinberg School of Medicine, said that the findings are especially upsetting given the rising suicide rates in our country among adults.

For youth between the ages of 10 and 24, suicide is the third leading cause of death, according to the Center for Disease Control and Prevention. In adolescents who have attempted suicide, there is an increased rate for a second suicide attempt within three months of the teen’s first attempt, he noted.

“This is the time when we really want to engage families and make sure the patients receive care,” Reinecke said.

The majority of youths in the study did not have lethal self-harm injuries when they came to the emergency rooms. However, adolescents with more severe self-harm injuries were not any more likely to be admitted to hospitals than those with less severe ones. This is a troubling find, said Jeff Bridge, an epidemiologist and one of the authors of the study conducted at Nationwide Children’s Hospital in Columbus, Ohio.

He and colleagues surveyed more than 3,200 adolescents nationwide to draw their conclusions.

Youths that seek care in emergency departments after deliberate self-harm should receive a comprehensive mental health assessment during the visit and referral to outpatient care when clinically indicated, Bridge said.

“Interventions are being developed to improve follow-up treatment and outcomes for youths with deliberate self-harm treated in emergency departments, but there is still much work that needs to be done,” he said.

While a self-harm injury does not necessarily mean a teen is suicidal, these injuries are often associated with a whole cluster of problems in adolescents. Depression is the most commonly seen illness in teens with self-inflicted injuries. Borderline personality disorder, in which adolescents have difficulty in regulating their emotions, is another. It is not unusual to see self-harm injuries in conjunction with eating disorders either, Castro-Blanco said.

Depending on the severity of the physical damage as well as the specific intent behind the injury, an adolescent may or may not be hospitalized. Castro-Blanco added that hospitalizing adolescents is difficult, and if it is clear that the patient did not intend to commit suicide, he or she may be discharged. 

The problem occurs in the follow up process of emergency room visits, according to Castro-Blanco. Self-harming adolescents are often given a psychiatric referral in emergency rooms, but when clinicians don’t follow up to see if the patient found help, problems can persist.

“The reality with a lot of teenagers is that they’re not going to self-refer for treatment in the first place,” said Castro-Blanco. In most cases it’s the family that brings the teen in for help. As a result, adolescents can be reluctant to begin treatment. But, if the teen’s family enhances the motivation to follow up, treatment can be more effective, Reinecke said.

Help can be difficult to find though, even if the teen and his or her family are willing to seek it. The availability and accessibility of quality care in emergency rooms is an ongoing concern for mental health professionals. The level of training that emergency room clinicians get in terms of mental health is highly variable, said Jason Washburn, an assistant professor at the Feinberg School of Medicine.

“We really need to provide more training and strategy in how to get the youth connected with the care that they need,” he said.