An autumn uptick in mental health visits to the ED is normal as school begins and days darken. This year the surge began unexpectedly early at Seattle Children’s, in August, with about 20 more visits to the ED for mental health concerns than in the previous year. September and October ED numbers are holding steady so far compared to prior years. The difference is the acuity. More kids are arriving with mental health concerns who require admission.

“We all feared the effect that isolation, the pandemic and general societal stress would have on kids,” says Russ Migita, MD, clinical director of Emergency Services. “It’s because of the great work PCPs are doing to support kids and their families that we aren’t seeing even higher numbers in the ED yet. But the busy season is just beginning. We all need to work together to advocate for more resources and options for patients and families in the community.”

“We are seeing more kids who are thinking and researching ways to harm themselves,” says Erika Miller, RN, clinical manager of Mental Health Consultations. She suggests reviewing Seattle Children’s tips for firearm safety screening and suicide screening pathway for patients age 10 and older. A 2016 study found that less than 15% of physicians regularly ask caregivers screening questions about firearm safety.

She also urges PCPs to coach parents on the following steps that may make a lifesaving difference:

  • Lock up harmful items, including firearms and medicines, both prescription and over-the-counter.
  • Keep other potentially harmful items out of easy reach, like ropes, chemicals and other hazardous items not needed in the home.
  • Have direct conversations with their child about their mood and if suicidal thoughts are occurring.
  • Put crisis lines in their phones (and have their kids do the same), so that they can be easily accessed in a crisis moment.


“Share with parents how you are coping as a parent, to model good strategies and normalize that this time is a challenge for everyone and they are not alone,” she says. She notes the Partnership Access Line (PAL) is an excellent resource for PCPs in prescribing medication, and Washington’s Mental Health Referral Service for Children and Teens helps families access local providers who have appointments available for outpatient mental health services.

Suicide is a global public health problem and the second-leading cause of death for youth ages 10 to 24.

  • Recent data shows 40% of 10th graders self-report symptoms of depression (feeling so sad or hopeless for 2 weeks or more that they stopped doing their usual activities). This data was collected before COVID.
  • Almost one in five 10th graders and 12th graders reported making a suicide plan within the past year; again, this data was captured before COVID-19.
  • Most students who reported feeling sad or hopeless said they have an adult to turn to for help. But 13% of 8th graders, 16% of 10th graders and 15% of 12th graders reported not having an adult to help them.


A vast majority of suicide attempts are impulsive and occur within an hour of ideation (thinking about attempting). Suicide attempts using firearms are far more lethal than attempts by medication overdose: 93% of suicide attempts by firearms result in death compared to 2% of medication overdoses. When access to lethal means is restricted, people are less likely to attempt suicide or to die by suicide.

This year, firearm sales nationwide hit new highs, with almost half of all firearm sales going to first-time buyers.


Firearm Safety

Suicide Screening

Mental Health Resources