There is an increase in the prevalence of children, teens, and young adults with mental health disorders and we are doing a better job of diagnosing these serious conditions in our patients. Unfortunately, there are simply not enough mental health providers to help care for these young patients. As a result, we suspect that the number of visits to emergency departments (EDs) by children with mental health problems has increased. This is addressed by a study by Kalb et al. (10.1542/peds.2018-2192) looking at national trends in ED visits for mental health concerns in youth ages 6 to 24 years between 2011 and 2015. The authors used a national survey to determine by diagnostic code a psychiatric ED visit and used US Census Bureau data to provide the denominator for determining visits per 1000 youths over time. During the 5 years studied, there was a 28% overall increase in visits (31.3 to 40.2 visits per 1000 youth) with the largest increases occurring in teens (54%), African-Americans (53%) and Hispanics (91%). Sadly there was also a significant increase in suicide-related visits. Remarkably, only 16% of patients in the ED with a psychiatric complaint were seen by a mental health professional during that visit.
So what can be done about this increase in mental health visits to EDs that lack the trained staffing or safe spaces to adequately help these children? We asked Drs. Thomas Chun and Susan Duffy from Brown along with Dr. Jacqueline Grupp-Phelan from UCSF to provide an accompanying commentary (10.1542/peds.2019-0251). The three authors of this editorial first analyze why there is an increase in children with psychiatric disorders coming to the ED and then discuss why the ED is not the best place for these children. They suggest interesting possible solutions being tried around the country. A notable one is better integrating mental health training into the core residency training of all pediatricians. Both the study and commentary are well worth your attention and in turn may offer some solutions worth trying in your community.
