A new study published in the journal Pediatrics shows that pediatric emergency department (ED) visits for mental health disorders have increased by 60% and visits for deliberate self-harm have increased 329%.
For the study, a research team from Nationwide Children’s Hospital evaluated the number and reason for mental health-related ED visits. They also looked at the geographic location of EDs and the overall number of children coming to each ED.
Prior research has shown that low pediatric volume EDs and EDs in rural settings are less prepared for all pediatric emergencies, and only one third of rural facilities have pediatric mental health policies or mental health transfer agreements.
“We would like children to go to their primary care provider or a psychiatrist, but EDs are the safety net for children with mental health disorders, and we need to be able to take care of them,” said Rachel Stanley, M.D., division chief of Emergency Medicine at Nationwide Children’s and the study’s senior author.
“Knowing why children are going to the ED is essential to making sure the EDs are prepared to treat them appropriately.”
Over the 10-year study period ending in 2016, most visits occurred at non-children’s EDs in both metropolitan and non-urban settings. The study evaluated children 5 to 17 years old, and data is representative of all U.S. emergency departments.
Overall, the biggest increase in ED visits was among 15- to 17-year-olds (68% increase), and while the rate grew among both males and females, it was more pronounced in girls (74% increase).
In addition, ED visits for substance use disorders increased by 75%, with alcohol-related disorders decreasing by nearly 40% and substance use disorders significantly increasing (over 150%). The rate of visits for deliberate self-harm increased 329%.
“Examining the characteristics of EDs that children present to was important because outcomes have been shown to be directly linked to the volume and geographic location of the EDs,” said Charmaine Lo, PhD, MPH, the study’s lead author and senior research scientist in Emergency Medicine at Nationwide Children’s.
More research is needed to identify solutions that will better equip all EDs with the tools, personnel and resources to better manage pediatric cases, especially those associated with mental health.
Universal screenings for suicidal ideation, a recent requirement of the Joint Commission, is one step to improving the quality of care for those being treated for behavioral health conditions.
The authors say telehealth services can offer greater access to behavioral health specialists who can provide screening, help with acute interventions, and support connections to continued care within the community, thereby avoiding long distance transfers, transportation costs and delays in care.
“The overall goal of our work is to improve preparedness of EDs for children,” said Stanley. “Large children’s hospitals with psychiatric providers can offer outreach services to these smaller EDs in the form of telehealth. Another solution is more training for emergency physicians and nurses so they know how to treat and triage children.”
Recently, a team of experts collaborated to develop and open a Psychiatric Crisis Department dedicated solely for youth and adolescents in a behavioral or mental health crisis. The Psychiatric Crisis Department opened in March 2020 at the Big Lots Behavioral Health Pavilion at Nationwide Children’s in Columbus, Ohio, the largest center of its kind on a pediatric medical campus.
The need for the Pavilion and others like it around the country are vital as one in five children is living with a significantly impairing mental illness that interferes with everyday life. Half of all lifetime mental health issues start by age 14.
Source: Nationwide Children’s Hospital