The incidence of child and adolescent psychiatric emergencies
has increased over the past 20 years.1,2 This rise in emergency
department (ED) mental health visits coincides with an overall
increase in ED use—from 89.8 million visits in 1992 to 107.5
million visits in 2001.3 Psychiatric presentations by children
and adolescents (often in the absence of medical complaints)
account for up to 5% of the total visits to an ED in a given
year2,4 and, in some reports, such presentations account for as
many as 16% of ED visits.5 Analysis of the National Hospital
Ambulatory Medical Care Survey database for utilization patterns
of emergency department pediatric mental health (EDPMH) visits
from 1993 to 1999 showed an overall increase in population-based
rates of EDPMH visits by year but without an increase in
diagnoses commonly thought to be emergent, such as suicide
attempt, self-injury, or psychosis.1 Instead, the most prevalent
diagnoses were substance use disorders, anxiety disorders, and
disruptive behavior disorde