In the flurry of early morning emails from hospital leaders about bed capacity, an increasingly common one is from our Pediatric Emergency Department (PED) listing growing numbers of young children and teenagers termed as “behavioral health boarders” awaiting admission to the child psychiatry units. The urgency and undertow of stretched resources is evident to the recipients of the message. The slow burning behavioral health crisis among mostly teenagers prompting urgent evaluation and management is felt by emergency rooms and hospitals across the United States (US). Can understanding times of the year with higher surges and specific mental health diagnoses help hospital operations and planning of ambulatory services to respond appropriately?
In this month’s Hospital Pediatrics, investigators from a tertiary care children’s hospital report on their experience with admissions of children with behavioral health complaints to their emergency department (ED) and hospital between 2015 and 2019 (10.1542/hpeds.2020-000653). Investigators focused on seasonal trends and specific mental health diagnoses. Not surprisingly, the percent of consultations by the Child and Adolescent Psychiatry Consultation-Liaison service in the ED and hospital over the study period increased by over 50%. Peaks in volume were noted during the fall and spring months which is not well understood but may be related to stress from the beginning and end of the school year. The most frequently presenting diagnostic category was depressive disorders followed by trauma or stressor-related disorders and a sizeable proportion of children presented with suicidality.
This is a timely study which I encourage you to read. I commend the authors for this important work especially given the events of the past year. The stress on our youth and hospital systems has been further exacerbated by the COVID-19 pandemic for many reasons. In pediatrics, although cases of COVID-19 in children in the US pale in comparison to adult cases, the impact of school closures, virtual learning, isolation, and parental stress on the mental health of children is yet to be fully recognized. From a hospital operations perspective, in my own institution, we face new challenges with behavioral health boarders in the PED who are asymptomatic and COVID-19 positive and need admission to psychiatric inpatient units, often at full capacity, who cannot accommodate patients needing isolation prompting even longer boarding times in the PED. This study highlights the ongoing and distressing behavioral health crisis among US children and offers insight to help target preventative efforts and hospital resources for this vulnerable population.