• Cadence F Bowden, Gala True, Sara Wiesel Cullen, Miranda Pollock, Diana Worsley, Abigail M Ross, Jeffrey Caterino, Mark Olfson, Steven C Marcus, and Stephanie K Doupnik.
• Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA.
• Ann Emerg Med. 2021 Nov 1; 78 (5): 628-636.

Study ObjectiveWe explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts.MethodsWe conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach.ResultsRespondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients.ConclusionClinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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