Mental health emergency room visits among children are on the rise: Experts point to a broken system

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Multiple emergency room visits for children experiencing mental health crises are on the rise, according to a new study. Experts say a broken system is to blame.

The study, published in the journal JAMA Pediatrics in December, looked at more than 200,000 patients ages 3 to 17 who visited emergency departments with mental health issues at 38 US hospitals between 2015 and 2020.

Those emergency room visits have increased by 8 percent annually, according to 300,000 visits assessed. The number of visits has increased by 6% annually. Young patients with psychotic disorders such as schizophrenia were 42 percent more likely to revisit the emergency room within six months, according to the study, with 13.2 percent of patients having a mental health revisit within six months .

“The psychiatric emergency department can be a lifesaver for young people with acute suicidal tendencies,” said Dr. Harold S. Koplewicz, president and medical director of the nonprofit Child Mind Institute, said in a statement to Yahoo News. “This study speaks volumes about the lack of school-based or outpatient programs. The system is broken.”

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Study points to overwhelmed caregivers of young patients with behavioral or psychological disorders increasingly relying on emergency care space for care.

“Families come in with their kids who have serious behavior problems, and families are really short on wits, you know,” Dr. study, he told the New York Times. “Their child’s behavior can be a danger to themselves, but also to the parents, to the other children in the house”.

The study found that young patients with thoughts of suicide or self-harm made up nearly 29% of the diagnosis group, followed by patients with mood disorders (23.5%), anxiety disorders (10.4%) and disruptive or impulse control. 9.7%). Overall, 13.2% of patients revisited the emergency department for a mental health emergency within six months. But patients with psychotic disorders, disruptive or impulse-control disorders and neurodevelopmental disorders were more likely to revisit than those with suicidal thoughts or who were in danger of self-harm.

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“When a child is having a meltdown or having a meltdown at home, many of them don’t have a child psychiatrist they can call for advice or to take them to see the next day,” Michael Enenbach, a psychiatrist and the clinical director of the Child Mind Institute, he told Yahoo News. “Often, it’s just a cycle of behavioral disturbances at home. They come to the hospital, they are fine, then they are discharged. Then it all happens a couple of days later because they don’t have access to treatment. So the only option for parents, if they feel insecure, is to go to the emergency room.”

But experts worry that psychiatric emergency rooms or general hospital emergency departments are not designed or equipped to provide the ongoing support needed by young people with chronic behavior problems.

“There is no bible on parenting. So when you have a really busy kid, it’s hard to know what to do,” she added Enenbach, who has also worked in children’s behavioral emergency rooms for 14 years.

“Emergency rooms are already too busy, especially with COVID and everything. They are not really equipped to deal with children. There are child psychiatrists on call in the ER, but they get very stressed out with a child throwing a tantrum or having an episode and they don’t know what to do. Our ER doctors don’t know what to do. Pediatricians don’t know what to do. It’s hard because it’s really disruptive to the whole ER.

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The study revealed that the majority of patients with mental health emergency department visits were girls (56.0% versus 44.0% boys); non-Hispanic whites (50.4% versus 1.6% Asian American, 17.3% Hispanic, and 22.3% non-Hispanic black). The research also found that predisposing social constructs linked to revisits included race and ethnicity, with non-Hispanic white patients more likely to revisit the emergency room and Asian American patients, Hispanic patients, and other races less likely to revisit. The use of drugs in emergency rooms, such as benzodiazepines or antipsychotics, has also increased in recent years and are used disproportionately on black and young patients aged 18 to 21, according to the study.

Mental health visits, the study found, may be linked to lack of access to health care, with public insurance and a certificate of insurance associated with shorter times between visits.

“Accessing outpatient care is really difficult, especially if you have Medi-Cal or Medicaid,” Enenbach said. “Very few insurance provided out there are providing services. Hence, this disproportionately affects lower socioeconomic groups. So it only clogs the emergency rooms.

According to the Child Mind Institute — whose teams of psychologists and other specialists offer evaluation and treatment for a wide range of conditions and concerns — about 70 percent of U.S. counties do not have a child and adolescent psychiatrist, and that the average time it takes between symptom onset and treatment took more than eight years, due to stigma, misinformation, and lack of access to care.

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“It would be helpful to train pediatricians more in mental health so they can address the key issues of these patients,” Enenbach continued. “Currently, pediatricians receive very little training in mental health. We need to find a way to educate the population, get more providers out there, get more child psychiatrists through medical schools, hire mental health professionals, and better educate pediatricians and doctors.”

He added that “improving collaboration between pediatrics and mental health” is also important. “He’s getting better, but we still have a long way to go,” she said.

The study highlighted Enenbach’s observation, signifying that the trends surrounding the issue of increasing mental health emergency room visits “have not decreased.”

“Better intervention services are needed for patients with a behavioral health crisis at the hospital and system levels to reduce pediatric mental health emergency room use and ensure access to appropriate follow-up care, particularly attention to those patients who are more likely to revisit,” the study authors concluded.

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