Dr. Mark Mullen welcomes Dr. Megan Schott, a child and adolescent psychiatrist specializing in pediatric emergency psychiatry, for a discussion on the escalating boarding crisis affecting youth in psychiatric emergencies. Dr. Schott, who has built pediatric emergency psychiatry programs from the ground up across multiple academic health systems, details how the presence of a trained child psychiatrist in the emergency department can reduce unnecessary admissions by more than half. The conversation examines the definition of boarding, the systemic and financial pressures that limit psychiatric bed availability for children, and the often-overlooked risks of inpatient hospitalization, including social, academic, and long-term consequences for young patients. The episode also features a supervision-style case discussion on managing a challenging conduct disorder presentation, along with a series of rapid-fire "hot takes" covering healthcare parity legislation, the risks social media platforms pose to adolescent safety, and practical guidance for emergency staff without access to a child psychiatrist. Takeaways:

Having a trained child and adolescent psychiatrist in the pediatric ED can drastically reduce psychiatric admission rates
Boarding is technically defined as remaining in the ED or on a medical floor for eight or more hours after a disposition decision has been made.
Inpatient psychiatric admission carries real risks for children, including social stigma, academic disruption, and potential long-term consequences.
Mobile crisis teams and psychiatric urgent care models offer promising alternatives to traditional ED-based psychiatric evaluation for lower-acuity cases.
Clinicians should openly acknowledge systemic limitations to patients and families rather than overpromising solutions that the current system cannot deliver.

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