News & Commentary

Mental Health Sends More Youths to ED


Frank Diamond

Emergency departments (EDs) saw a 28% jump in the admittance of young people aged 6 to 24 for psychiatric problems between 2011 and 2015, according to a study published in Pediatrics.

Just why that happened is difficult to nail down, according to Luther Kalb at Johns Hopkins and his colleagues.

“Ultimately, it is unclear if the findings represent a change in identification (by providers) or reporting (by patients or family members) of mental health in the ED, a shift in the epidemiology of psychiatric disorders in the United States, or fluctuations in referral patterns or service-seeking behavior,” Kalb and his colleagues stated.

But something is going on and the findings garnered some headlines and clicks in March.

ED visits rose 54% for teens aged 12–17. They rose 53% for all African-American youngsters, and 91% for all Latino youngsters.

Kalb and colleagues looked at data from the 2011–2015 National Hospital Ambulatory Medical Care Survey, as well as a national survey of ED visits across the United States. EDs are 24/7 operations, so it makes sense in a way that they’re where parents and guardians take children under psychological duress.

The ED visits were classified as being connected to mood (depression, mania and/or hypomania, or anxiety), substance use disorder, psychosis, and other psychiatric reasons (personality disorder or mental health procedure). There were also classifications for suicide attempt and intentional self-harm.

“Because the ED is designed as an urgent medical facility, this setting often lacks the resources required to identify and manage psychiatric populations,” the study stated. “Discharge planning is also a challenge because the wait for outpatient psychiatry is long and inpatient psychiatric beds are a dwindling resource.” Fifty-one percent of ED pediatric psychiatric visits lasted three hours or more.

These are factors contributing to the long wait times for youngsters admitted with psychiatric problems.

In an email exchange with Reuters, Kalb said that “using the ED as psychiatric crisis center needs to change. We need to find new ways to get to people in times of need where they are at, rather than rely on the ED.”

The study pointed out that different approaches to psychiatric crisis intervention should be attempted, such as telemedicine, mobile crisis centers, and peer crisis services. Also, there should be centers with evening hours that focus on mental health problems.

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