Profile of paediatric mental health presentations to Australian emergency departments in 2018.

Objectives: Paediatric mental health presentations to emergency departments (EDs) are rising. Rural/Regional mental health service users face structural barriers to accessing general and specialist treatment, including physical distance and local service capacity and funding constraints. However, differences in patient characteristics and treatment pathways between major city and rural/regional EDs remain unclear. This study aimed to compare demographic and clinical profiles of paediatric mental health patients within each location.

Methods: Retrospective cohort study of paediatric (aged 0-17 years) mental health presentations at 23 Australian EDs (metropolitan=18, rural/regional=five) from 1 January to 31 December 2018. At each site, up to 100 randomly selected unique patient medical records were included. Demographic and clinical characteristics were compared using logistic and linear mixed effects regression models.

Results: 2234 young people were recruited (metropolitan=1803, rural/regional=431). Mean age was 14.4 years (SD=2.6) and 59.4% were female. Frequent presentation reasons were suicidal ideation (853; 38.2%), self-harm (668; 29.9%) and behavioural disturbance (306; 13.7%). Of those with complete documentation, 703 (70.9%) had family history of mental illness and 933 (41.8%) reported recent interpersonal difficulties (eg, family/peer conflict). Three hundred and twenty-nine young people (14.7%) were admitted and 1024 (45.8%) were referred to public child and adolescent mental health services (CAMHS). Patients in rural/regional settings had shorter median waiting times for ED clinicians (24 vs 42 min) and mental health assessments (1.1 vs 2.5 hours), shorter median ED length of stay (2.9 vs 4 hours) and higher likelihood of referral to CAMHS on discharge (OR 2.19, 95% CI 1.22, 3.93).

Conclusions: Characteristics of children and adolescents presenting with mental health concerns are broadly similar between metropolitan and rural/regional EDs, but treatment characteristics differ. Frequency of family mental illness and interpersonal difficulties highlights the benefits of family focused interventions. Given similar patient profiles, equitable resourcing of rural/regional services is warranted.