Schools need to explore alternatives to ER for students with mental health concerns

The article “As health costs rise, a push to curb ER visits” (Page A1, Dec. 12) highlights the importance of alternatives to hospital emergency department care for many health care difficulties. However, it does not address mental health cases and, in particular, the large number of children seen in emergency departments, due to threats of self-harm, who are referred by school departments. These schools routinely insist on clearance through a behavioral health assessment in order for the child to return to school.

The vast majority of these children screen negative for elevated risk to self and return to school the next day. Many of these children spend a good part of the day in emergency departments. These visits are expensive and absorb considerable staff resources and time.


School departments need to commit to first-tier on-site risk assessment and the building of strong relationships with community providers who can complete timely evaluations, as needed, following school-based evaluation. This can sometimes involve mental health clinicians with whom some of these children are already in service.

Jerrold Pollak

Portsmouth, N.H.

The writer is a clinical and neuropsychologist and an emergency mental health services clinician.