Suicide is consistently among the three leading causes of death among adolescents and young adults ages 10 to 24 years in the United States. Locally, the impact of suicide has been felt at The University of Pennsylvania, with 6 of its students completing suicide in a 13 month span. A recent New York Times article highlights the pressure many high-achieving students feel, particularly at elite colleges and universities. These young adults may appear to have it all together from an outsider’s perspective, but inside they carry a heavy emotional burden.
We must not assume we know what is going on in someone’s life, and need to consider that all adolescents are at risk. Therefore, we as medical professionals cannot be selective with whom we screen. Nearly 75 percent of adolescents have had contact with a medical professional within 4 months prior to committing suicide.
As healthcare providers, we have an opportunity to detect those who may need our help and intervene when necessary. The emergency department (ED) at CHOP serves as a safety net for patients, and all adolescents ages 14 to 19 years are screened regardless of the reason why they present to us.
Electronic Behavioral Health Screen
Although providers talk to patients alone during their medical encounters to ask about mental health, not all adolescents initially feel comfortable discussing their feelings. But with an electronic Behavioral Health Screen, completed by over 300 adolescents each month, we often discover how they are truly feeling. The Behavioral Health Screen is a 10 minute survey composed of 50 questions, covering domains of depression, suicidal ideation, trauma, and substance abuse.
One-third of the screenings completed each month reveal symptoms of severe depression or suicidal ideation, and many patients who screen positive did not initially come into the ED with a mental-health complaint. Oftentimes, they present with non-specific symptoms such as headache, chest pain, and abdominal pain.
Acknowledging the growing issue of mental health disease, quality improvement initiatives and research at CHOP aim to improve the care provided to patients with mental health concerns. In the ED, if a patient has a concerning Behavioral Health Screen, including symptoms of severe depression or suicidal ideation, the ED’s comprehensive team of social workers and psychiatrists work with patients and their families to determine the next steps of care. If an adolescent is deemed safe for discharge after appropriate evaluation, patients and families are given resources and referrals for mental health services. To improve follow up for those at high risk, the ED communicates findings to primary care providers to ensure follow up.
As medical professionals, we are constantly thinking about what diseases and injuries could be harmful or life-threatening to our patients. While many ailments can be treated with a single medication or with surgery, mental health disease and suicidal ideation requires a careful and multidisciplinary approach. By eliminating our assumptions about patients from what is projected on the outside and screening all adolescents in the ED, we can potentially save many lives.
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