ORIGINAL ARTICLE
Treating Psychiatric Emergencies in Incarcerated Minors in the Emergency Department What Is the Cost and What Is Their Disposition? David Brian Wood, BS,* Joy Joelle Donofrio, DO,Þ Genevieve Santillanes, MD,þ Chun Nok Lam, MPH,þ and Ilene Claudius, MDþ
Background: Although mental health disorders are common among incarcerated minors, psychiatric urgencies and emergencies often cannot be treated in juvenile detention facilities, necessitating emergency department (ED) transfers. The cost of this ED care has not been well studied. Objective: This study aimed to provide information on disposition and cost related to ED visits by juvenile hall patients transported for urgent psychiatric evaluation. Methods: A retrospective cross-sectional descriptive study of patients presenting to 1 ED from juvenile detention centers for consideration of psychiatric holds was conducted. Eligible patients were identified by a search of the International Classification of Diseases, Ninth Revision, discharge diagnosis codes and chart review. We collected information on patient demographics and disposition and calculated costs of ED visits, screening laboratories performed, inpatient stays on a medical ward, sitter and parole officer salaries, and ambulance transfers. Results: One hundred eight patients accounting for 196 visits were transported from juvenile hall for urgent psychiatric evaluation. Of the 196 visits, 131 (67%) resulted in an involuntary psychiatric hold. More than half of the patients on hold (75 patients) were admitted to a medical ward for boarding because of lack of psychiatric inpatient beds. Included charges for the 196 visits during the 18-month period totaled US $1,357,884, with most of the costs due to boarding on the medical ward. Conclusions: We describe the magnitude and cost associated with addressing psychiatric emergencies in a juvenile correctional system relying on transport of patients to an ED for acute psychiatric evaluation and treatment. Further research is needed to determine if costs could be decreased by increasing psychiatric resources in juvenile detention centers. Key Words: emergency psychiatric services, mental health, juvenile delinquency, prisoners, health care costs (Pediatr Emer Care 2014;30: 403Y408)
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he relationship between mental health disorders and incarceration in adults is well recognized. Up to 61% of US adult prisoners carry 1 mental health diagnosis1 and 15% to 24% have a serious mental health disorder.2 In Los Angeles County,
From the *Keck School of Medicine of University of Southern California; †Department of Pediatrics, LAC + USC Medical Center; and ‡Department of Emergency Medicine, LAC + USC Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA. Disclosure: The authors declare no conflict of interest. Reprints: Genevieve Santillanes, MD, Department of Emergency Medicine, LAC + USC Medical Center, 1200 N State St, GH 1011, Los Angeles, CA 90033 (e
Treating Psychiatric Emergencies in Incarcerated Minors in the Emergency Department What Is the Cost and What Is Their Disposition? David Brian Wood, BS,* Joy Joelle Donofrio, DO,Þ Genevieve Santillanes, MD,þ Chun Nok Lam, MPH,þ and Ilene Claudius, MDþ
Background: Although mental health disorders are common among incarcerated minors, psychiatric urgencies and emergencies often cannot be treated in juvenile detention facilities, necessitating emergency department (ED) transfers. The cost of this ED care has not been well studied. Objective: This study aimed to provide information on disposition and cost related to ED visits by juvenile hall patients transported for urgent psychiatric evaluation. Methods: A retrospective cross-sectional descriptive study of patients presenting to 1 ED from juvenile detention centers for consideration of psychiatric holds was conducted. Eligible patients were identified by a search of the International Classification of Diseases, Ninth Revision, discharge diagnosis codes and chart review. We collected information on patient demographics and disposition and calculated costs of ED visits, screening laboratories performed, inpatient stays on a medical ward, sitter and parole officer salaries, and ambulance transfers. Results: One hundred eight patients accounting for 196 visits were transported from juvenile hall for urgent psychiatric evaluation. Of the 196 visits, 131 (67%) resulted in an involuntary psychiatric hold. More than half of the patients on hold (75 patients) were admitted to a medical ward for boarding because of lack of psychiatric inpatient beds. Included charges for the 196 visits during the 18-month period totaled US $1,357,884, with most of the costs due to boarding on the medical ward. Conclusions: We describe the magnitude and cost associated with addressing psychiatric emergencies in a juvenile correctional system relying on transport of patients to an ED for acute psychiatric evaluation and treatment. Further research is needed to determine if costs could be decreased by increasing psychiatric resources in juvenile detention centers. Key Words: emergency psychiatric services, mental health, juvenile delinquency, prisoners, health care costs (Pediatr Emer Care 2014;30: 403Y408)
T
he relationship between mental health disorders and incarceration in adults is well recognized. Up to 61% of US adult prisoners carry 1 mental health diagnosis1 and 15% to 24% have a serious mental health disorder.2 In Los Angeles County,
From the *Keck School of Medicine of University of Southern California; †Department of Pediatrics, LAC + USC Medical Center; and ‡Department of Emergency Medicine, LAC + USC Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA. Disclosure: The authors declare no conflict of interest. Reprints: Genevieve Santillanes, MD, Department of Emergency Medicine, LAC + USC Medical Center, 1200 N State St, GH 1011, Los Angeles, CA 90033 (e
