A new study published in the Journal of Pediatrics looked at the number of times children visited emergency departments in the U.S. for mental health care.
“The purpose of this study was to describe the trends in pediatric mental health emergency department (ED) visits on a national scale,” lead study author, Charmaine Lo told us. “We know from other studies that often times, low pediatric volume and/or EDs located in non-metropolitan areas tend to be less prepared to treat children, as they may only see a few children a day.”
Lo is the senior research scientist in Emergency Medicine at Nationwide Children’s Hospital. Researchers were interested in seeing how many children seek care at EDs of different sizes and settings (e.g. children’s hospital vs non-children’s hospital). They believed that whatever they found would align with the more established literature regarding broad trends of pediatric ED visits.
“We thought that ED characteristics could potentially have a link to preparedness, but this study is a descriptive study,” Lo told us, “and our future work will afford us the opportunity to explore that further.”
Researchers noticed that she and the rest of the team were seeing more children with mental health disorders in their EDs and the comfort level of their clinicians treating these patients varied.
“That made us more curious, because if comfort level was so variable at a well-resourced institution, such as ours, what was it like in other, general EDs that may not have access to specialized pediatric psychiatrists and other resources?” Lo told us.
An analysis of data was conducted from the 2007-2016 Healthcare Cost and Utilization Project’s National Emergency Department Sample (HCUP NEDS). The number of ED visits made by children, 5-17 years with a mental health disorder was assessed. In particular, researchers looked at the characteristics of each ED, such as pediatric volume, where it was located (e.g. urban vs rural), and whether or not it was a children’s hospital.
“While ED visits among children were stable over the ten year study period, we found that visits for all mental health disorders rose 60 per cent,” Lo told us. “When we looked at different broad categories of mental health, we found that substance use disorder rose 160 per cent while alcohol use disorders fell by 40 per cent.”
Visits to EDs by children with mental health disorders occurred in EDs of all pediatric volumes and in all locations. This was concerning as other studies have shown that EDs that are rural or those that see small numbers of children are less prepared to treat children and that has an effect on health outcomes.
“We were surprised by how pronounced the rates were, particularly among the substance use and deliberate self-harm groups,” Lo told us. “We were expecting a rise but not to the levels that we observed.”
The fact that children are more likely to receive care in non-children’s hospitals aligns with previous studies.
“We think that this highlights the need for all EDs regardless of location or primary population served, to be better prepared to care for children with mental health disorders,” Lo told us. “This can happen through more mental health education and training for all providers in the ED, developing transfer agreements, utilizing toolkits and other resources to increase preparedness, and expanding the use of telehealth as a resource for providers to consult with specialists at EDs with more resources.”
Resources are available, both for providers and families but during this stressful time of COVID-19, families seem to be avoiding the ED for all types of care, including emergency mental health visits.
“We encourage any children and families who feel the need to seek mental health care to contact their pediatrician with their concerns,” Lo told us, “but also not to be afraid to seek help in the ED if they feel they need to.”
Patricia Tomasi is a mom, maternal mental health advocate, journalist, and speaker. She writes regularly for the Huffington Post Canada, focusing primarily on maternal mental health after suffering from severe postpartum anxiety twice. You can find her Huffington Post biography here. Patricia is also a Patient Expert Advisor for the North American-based, Maternal Mental Health Research Collective and is the founder of the online peer support group - Facebook Postpartum Depression & Anxiety Support Group - with over 1500 members worldwide. Blog: www.patriciatomasiblog.wordpress.com