ERs overwhelmed by children’s mental health crisis, warn U.S. doctors’ groups.

ERs overwhelmed by children's mental health crisis, warn U.S. doctors' groups.

The Crisis of Pediatric Mental Health Emergencies in American Emergency Rooms

America’s emergency rooms are currently facing a surge of children suffering from psychiatric emergencies, including anxiety, depression, and suicidal thoughts or attempts. A recent joint report from the American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), and Emergency Nurses Association (ENA) warns that this alarming increase in pediatric mental health cases has overwhelmed ERs in the United States.

Dr. Mohsen Saidinejad, the lead author of the report and the director of pediatric emergency medicine at the Ronald Reagan UCLA Medical Center, highlights the challenges faced by ERs when it comes to providing proper mental health care. While ER physicians can screen and identify at-risk individuals, they are not equipped to offer definitive care. As a result, children seeking help for mental and behavioral health issues in the ER are less likely to receive the ongoing care they truly need.

The statistics paint a concerning picture. Every year, around half a million children with mental and behavioral health problems are evaluated in ERs. From 2007 to 2016, ER visits related to mental health problems increased by 120% at children’s hospitals and by 55% at general hospitals. The stress and strain of the pandemic have further intensified this crisis, leading to even more pediatric mental health emergencies.

Dr. Madeline Joseph, a pediatric emergency physician at the University of Florida Health, highlights the complexity of cases involving pediatric mental health crises. These cases often require a much longer hospital stay compared to other ER visits, with an average stay of 17 hours. Unfortunately, it is not uncommon for patients with mental and behavioral emergencies to stay in the ER for over 48 hours, exacerbating their situations. The extended stays for these complex cases also drain resources needed for other patients and the normal operations of the ER.

Moreover, ER teams are designed to work quickly, moving from case to case, but children in psychiatric crisis need follow-up care that ERs cannot provide. According to Dr. Saidinejad, about 80% of children who come to the ER with mental and behavioral health concerns can be safely discharged but require close outpatient follow-up. However, the current healthcare system lacks an effective connection between the ER and the child’s primary care doctor, inhibiting the proper continuity of care.

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To improve mental health treatment in emergency departments, the joint report recommends various measures, including dedicated spaces for psychiatric screening, the use of good screening tools, and providing one-on-one treatment and monitoring for at-risk patients. However, the ideal scenario would involve referring these children to psychiatric crisis centers or community mental health centers instead of the ER.

Primary care doctors, paramedics, and other emergency workers should have access to comprehensive lists of psychiatric providers in each community to determine the most suitable destination for a patient in crisis. However, many communities lack adequate mental health resources, with one mental health professional available for every 124,000 children. Increasing mental health resources and implementing solutions like mental health mobile crisis teams and telehealth options could alleviate the pressure on ERs and provide better care for children in need.

In conclusion, the rise in pediatric mental health emergencies has placed an overwhelming burden on American emergency rooms. ERs are not equipped to provide the ongoing mental health care these children require, resulting in longer stays and limited access to follow-up care. To address this crisis, it is crucial to strengthen the mental health care system, improve access to care in communities, and establish effective connections between the ER and primary care doctors. By doing so, we can provide better support and treatment for children facing mental and behavioral health challenges.