Have you noticed that visits to the emergency department (ED) for children presenting with mental health issues seem to be increasing? Lo et al (10.1542/peds.2019-1536), in a study being early released, evaluated the readiness of emergency departments to manage mental health issues in children. The authors used a large national ED database examining the number of visits made by children and teens (ages 5-17 years) with a mental health disorder between 2007 and 2016. The authors reviewed patient volumes over time, types of visits, as well as ED characteristics, including whether it was in a rural community or whether it was exclusively pediatric.
The authors findings are concerning. While overall pediatric ED visit volumes remained constant over the decade studied, visits for mental health disorders in the ED went up 60%. There were large increases in the number of visits for self-harm (329%) and substance use disorders (159%). These increases were notable for EDs regardless of type, location or volume, although some of the most substantive increases in mental health visits were seen in non-pediatric EDs with low pediatric volume and in rural areas.
Why is this happening and why are these rising numbers of pediatric and adolescent mental health visits to EDs a problem? To answer that question, we asked Pediatric Emergency Medicine specialists Drs. Jennifer Hoffmann from Lurie Children’s Hospital in Chicago and Ashley Foster from Boston Children’s Hospital to weigh in with an accompanying commentary (10.1542/peds.2019-3542). Drs. Hoffman and Foster highlight the repercussions are of having more and more children with mental health issues occupying beds in EDs. The authors of this commentary also focus on the opportunities that non-pediatric rural hospitals must be better prepared to care for these children. Drs. Hoffman and Foster also provide some solutions to consider addressing the high number of patients with mental health issues seen in EDs. If you want to improve mental health care for children in your practice so they don’t need the ED, then be mindful of this study and commentary which are both full of useful data and analysis to improve the delivery and access of mental health care services to children and teenagers in this country.