Helping young people in crisis in the ER

Everyone agrees the ER is not the optimal place for children and youth to go to in a mental health and substance use (MHSU) crisis, but people are desperate for help. In the words of one mother "It was 11 pm, my daughter was suicidal, I didn't know what else to do," she recalls.

Once there, many face challenges of long waits within often chaotic and stressful environments, and finding support after discharge can be problem.

It's not just the patients who are struggling. ER staff can also feel frustrated as they work to accurately assess and support these vulnerable patients.

Addressing these challenges was the impetus for the creation of the ER Protocol as part of the work of the ER Working Group of the CYMHSU Collaborative - a Shared Care initiative of Doctors of BC and the BC government.  

Dr Jeff Peimer, an ER physician in Williams Lake, was a key champion of the protocol, and was joined on the Working Group by another ER physician, three psychiatrists, two pediatricians, school counsellors, staff from Ministry of Children and Family Development, and others. Together, the group developed the protocol's five key steps to ensure a consistent approach to care in the ER. One of the five steps incorporated an assessment tool (HEARTSMAP) developed by Dr Quynh Doan, an ER physician at BC Children's Hospital. Training for the ER protocol is now taking place across the province with the help of all local Health Authorities (HAs).

Dr Slabbert, a GP in Quesnel, helped to spearhead the training and implementation of the new protocol at his local hospital. "The protocol has improved standardization", says Slabbert as he describes how physicians, nurses, and allied health staff all previously did their own assessments in the ER. "Now staff are trained to all use the same tools and processes."  

Slabbert also sees how the psycho/social assessment tool provides reassurance to parents, and increases staff confidence. "Parents can see that there are other options besides referral to a psychiatrist, says Slabbert. "Before we were treating everyone the same out of fear, which meant we were under-treating some, and over-treating others, he says.  Slabbert also notes that action plans, and increased communication between providers, is making sure follow up takes place.  

Quesnel is one of 30 hospitals in the process of implementing the protocol, and many more are ready to get on board.

ER Protocol Training Video

As a way to easily train staff and spread the protocol to other hospitals and regions, the Collaborative also created a short ER protocol training video and accompanying fact sheet. Both can be uploaded to HA websites for ongoing access, and can be found on the Collaborative's Toolbox here.