Disruptive Behavior and Difficult Adolescents in the Emergency Department : Contribution to a Comparison between France and Canada
For the last two decades, mental health related visits for adolescents in the Emergency Department (ED) have been a developing issue in North America as well as in Europe. When emerging, this issue met two opposite apprehensions in the medical community. If all authors agreed that this trend reflected unmet mental health needs and was connected to certain clinical and social characteristics of the patients, they were opposed on the legitimacy of these demands.
We focused on the political and institutional background against which this trend occurred and we analyzed how it was detected as an issue by these actors at hospital.
A critical review of medical literature on the topic was performed, comparing its approach in France and in Canada. This review was compared to institutional and policy making reports. Data were analyzed with conceptual tools from the pragmatist sociology on public issues.
ED patients more often received social welfare benefits, had a social or correctional follow-up and belonged to ethnic minorities. Self-harm and violence represented the two main complaints. However, gender played a role. Female adolescents more frequently reported depression symptoms or self-injuries while male were admitted for violence. The population of disruptive behavior and violent adolescents is at higher risk of returning to the ED. Recent researches have shown that making contact with outpatient care did not prevent ED readmission and even facilitated it. With rare exceptions, no specific intervention has proven efficiency in preventing readmissions to the ED. Standards of care and evidence-based references for practice are lacking. Ethical issues regarding the use of constraint (seclusion, physical and or chemical restraint) to treat these adolescents add to the trouble of professional caregivers.
We propose a future ethnographic fieldwork in the ED.