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Follow-up From a Pediatric Mental Health Emergency Visit

February 14, 2023

The American Academy of Pediatrics (AAP) has called the mental health crisis affecting youth a national emergency. Each of us who cares for children and adolescents would agree with this AAP declaration given the high volumes of our patients being seen in emergency departments (EDs) because they cannot access appropriate outpatient care. What happens after an ED visit for mental health services? Can follow-up to outpatient mental health services reduce the burden of subsequent ED visits and hospitalizations? 

Hoffman et al (10.1542/peds.2022-057383) share with us in an article being early-released this month in Pediatrics an analysis of Medicaid claims data from more than 28,500 children ages 6 to 17 years in 11 states who had a mental health ED discharge in 2018-2019. The authors study objectives were to determine the proportion of outpatient mental health follow-up within 7 and 30 days after the ED visit and to analyze variations by sociodemographic and clinical characteristics, and whether having timely outpatient follow-up was associated with a decreased risk of a return visit to the ED or a MH hospitalization in the subsequent 6 months.

The findings reported in this study are sobering, starting with the fact that less than a third of children and teenagers had a follow-up mental health visit within 7 days and less than 60% of these youth had one within 30 days. There were notable differences in the likelihood of follow-up by sociodemographic and clinical factors. Those who had no prior history of ED mental health visits were much less likely to have a subsequent outpatient mental health visit within one month. Follow-up within 7 days and 30 days was associated with decreased ED mental health visits within 5 days of the initial ED visit; it did not reduce return ED visits or hospitalizations afterwards.

Why are the follow-up visits so low? The authors provide some thoughts in the discussion section of their study. We also obtained a provocative commentary from Drs. Hannah Karpman, Jean Frazier, and Sarabeth Broder-Fingert (10.1542/peds.2022-058832), experts at the University of Massachusetts on the topic of the mental health crisis. They highlight the concerning findings in this study in their commentary and provide a two-step call for action. Step one is to advocate for an immediate overhaul of community-based mental health support systems given how many youth currently lack access to the services needed to prevent ED visits and hospitalizations and this situation is only getting worse. Step two is to recognize the need for a massive investment in expanding education, training, and adequate compensation of the workforce for addressing pediatric mental health issues. Link to this study and commentary and learn more.

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