Currently configured as urgent medical care facilities, emergency departments (EDs) typically lack the expertise required to appropriately assist psychiatric populations. It is estimated that greater than 10% of United States youth has a serious psychiatric disorder. Youth and young adults are often motivated to visit the ED because of chronic and acute mental health issues that are not adequately addressed elsewhere and because EDs can’t turn them away. Adolescent visits due to suicidal attempt, self-injury, or both are rising. Indeed, a recent national survey found that 60% of child and adolescent psychiatrists recommended that parents take their child to the ED during a crisis. With this influx, pediatric psychiatric patients face excessively long wait times in the ED. Both funding and implementation of evidence-based interventions are imperative in effectively assisting families and young adults during times of mental crisis. With the ED serving as an entryway to the mental health system for many children, it is important to understand psychiatric ED use among this patient population. “Use of the ED for mental healthcare is an indicator of population health,” says Luther G. Kalb, PhD. “A rise in these visits suggests there are important changes needed in community health and/or provider behavior (eg, better detection).”
Taking a Deeper Look
For a study published in Pediatrics, Dr. Kalb and colleagues examined psychiatric ED visits among US youth and young adults in order to determine if the trend of increasing mental health-related ED visits seen in prior research was increasing further, particularly for suicide-related visits. The study team also sought to examine various risk factors and populations, as previous studies mostly assessed overall trends.
Dr. Kalb and colleagues used ED data obtained from the 2011-2015 National Hospital Ambulatory Medical Care Survey. They identified psychiatric ED visits using ICD-9 and reason-for-visit codes. Using survey-weighted logistic regression analyses, they examined trends in, as well as correlates of, psychiatric ED visits. Study participants were pediatric psychiatric ED visitors (aged 6 to 24) across the US.
“Our results showing 1 in 10 Emergency Department visits were for psychiatric reasons, in 2015, are quite high,” says Dr. Kalb. “Schools, outpatient providers, and families are often solely relying on one source for 24/7 urgent care: The emergency department. We either need to create new models for crisis care or adequately equip the emergency department with psychiatric expertise.
The fact that only 1 in 6 youth who visited the Emergency Department for psychiatric purposes saw a mental health provider is concerning…This finding suggests a lack of psychiatric expertise, specifically, in this setting.”
Examining Key Findings
Results of the study showed that between 2011 and 2015, there was a 28% overall rise in psychiatric ED visits, from 31.3 to 40.2 per 1,000 US youth, the largest of which was seen among adolescents (54% increase), African-American patients (53% increase), and Hispanic patients (91% increase). Results also showed a significant, 2.5-fold increase in adolescent suicide-related visits (from 4.6 to 11.7 visits per 1,000 youth). “Psychiatric emergency department visits are substantially increasing among adolescents (aged 12-17),” adds Dr. Kalb (Table). “Suicide-related visits are increasing among adolescents only, and that increase was very large. Young adults (aged 18 to 24) were the most frequent users of the ED for psychiatric purposes.” Further examination of psychiatric ED visits among young adults is crucial, as many children begin to show signs of serious psychiatric disorders in young adulthood.
A mere 37% of adolescents who attempted suicide and/or self-injury actually met with a mental health professional during their ED visits. Furthermore, only 16% of all psychiatric patients met with a mental health provider at their ED visits, despite 51% of visits lasting 3 hours or longer and 1 in 5 lasting longer than 6 hours.
While the ultimate goal, according to Dr. Kalb and colleagues, is to arm families and young adults with mental health resources outside of the ED, the ED will likely remain a significant part of treating both acute and chronic mental health issues. Therefore, he supports the “continued need to outfit EDs with the expertise to identify and treat mental health problems” and recommend that EDs look into new methods of crisis intervention (eg, mobile crisis centers, peer crisis services, and telemedicine) or develop a new framework for urgent mental health care.