A Moving Target: Firearm Deaths, Mental Health, and the Role of Physicians.

Purpose Of Review: This review aims to provide an updated overview of trends in firearm- related deaths, the mental health impact on communities, and clinical and legislative interventions. We examine existing interventions and highlight lesser-known yet impactful strategies, such as incorporating appropriate training in medical education on firearm safety. Additionally, we explore the broader impacts of firearm violence on community mental health and address the disputed topic of whether mental illness is a driving factor behind mass shootings.

Lessons of the Boom: A Playbook for Crisis Centers to Prevent, Survive, and Respond to Active Assailants, Targeted Violence, and Mass Violence.

Modern crisis centers need to be prepared for mass shootings, active assailant incidents, and related forms of targeted violence. While crisis engagement has traditionally been seen as a "right of boom" or post-incident responder, crisis leaders need to prepare their teams to identify people at risk for violence, use tools like Behavioral Threat Assessment and Management to reduce risk in those persons, and prepare their teams for potential incidents in their community. Evidence suggests that acute stressors are a common proximal risk factor for severe violence implying a potential synergy for using crisis services as a tool for prevention of violence.

Safe Spaces: Mitigating Potential Aggression in Acute Care Psychiatry.

Awareness of potential aggression and violence is crucial when treating patients experiencing mental health crises in psychiatric emergency and inpatient settings. To provide a practical overview for health care workers in acute care psychiatry, the authors summarize relevant literature and clinical considerations on this important topic. Clinical contexts of violence in these settings, possible impact on patients and staff, and approaches to mitigating risk are reviewed.

Revisiting "Excited Delirium": Does the Diagnosis Reflect and Promote Racial Bias?

Introduction: "Excited delirium" (ExD) is purported to represent a certain type of agitated state that can lead to unexpected death. The 2009 "White Paper Report on Excited Delirium Syndrome," authored by the American College of Emergency Medicine (ACEP) Excited Delirium Task Force, continues to play a pivotal role in defining ExD. Since that report was produced, there has been an increasing appreciation that the label has been applied more often to Black people.

Mental Health Care of Detained Youth Within Juvenile Detention Facilities.

Mental health treatment of juvenile offenders and undocumented immigrant youth in detention provides a unique opportunity for treatment providers. Although the work may be challenging, the clinical needs and opportunities for early and meaningful interventions are significant. One of the best clinical experiences a psychiatrist can have is working with extremely high-risk youth to help them find safer and better developmental pathways.

Evaluating threats of mass shootings in the psychiatric setting.

Psychiatrists may encounter patients at risk of perpetrating mass shootings or other mass violence in various settings. Most people who threaten or perpetrate mass violence are not driven by psychiatric symptoms; however, psychiatrists may be called upon to evaluate the role of mental illness plays in the risk or threat, and to treat psychiatric symptoms when present. Regardless of whether psychiatric treatment is likely to reduce symptoms or the potential for violence, the psychiatrist should collaborate closely with law enforcement, potential targets, and other agencies involved to mitigate risk.

Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals.

Purpose: Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals.

American Association for Emergency Psychiatry Recommendations to Address Psychiatric Staff Shortages in Emergency Settings.

Objective: The psychological sequelae of the COVID-19 crisis will increase demands for psychiatric care in already strained emergency and mental health systems. To address the shortage of psychiatrists (and nurse practitioners and physician assistants) in emergency settings (ESs), the American Association for Emergency Psychiatry (AAEP) has established recommendations for utilizing nonprescribing mental health professionals in the evaluation and management of psychiatric patients in these contexts.

Methods: Faced with limited research on the roles and competencies of nonprescribing psychiatric emergency clinicians (PECs), a multidisciplinary committee of members of AAEP was tasked with developing recommendations for use of PECs.

Management of Agitation During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic caused by the coronavirus SARS-CoV-2 has radically altered delivery of care in emergency settings. Unprecedented hardship due to ongoing fears of exposure and threats to personal safety, along with societal measures enacted to curb disease transmission, have had broad psychosocial impact on patients and healthcare workers alike. These changes can significantly affect diagnosing and managing behavioral emergencies such as agitation in the emergency department.

Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders.

Introduction: Patients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain.

Methods: In December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups.

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice.

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy.

Violence in the Emergency Department.

Violence is common in the emergency department (ED). The ED setting has numerous environmental risk factors for violence, including poor staffing, lack of privacy, overcrowding, and ready availability of nonsecured equipment that can be used as weapons. Strategies can be taken to mitigate the risk of violence toward health care workers, including staff training, changes to the ED layout, appropriate use of security, and policy-level changes.

Mental Health Care of Detained Youth and Solitary Confinement and Restraint Within Juvenile Detention Facilities.

Justice-involved youth are a complex and heterogeneous population with extremely high rates of mental disorder, trauma, and numerous other psychosocial stressors. Although working with this population has several challenges it can be highly rewarding for clinicians and a powerful opportunity for prevention of subsequent problems. Psychosocial interventions remain some of the most robust and effective interventions targeting specific developmental deficits common in this population.