ED visits for mental health crises on the rise

Luther Kalb, PhD

The number of teenagers and young adults turning to the emergency department (ED) in times of mental crises is on the rise, according to new research.

The report, published in Pediatrics, reveals a 28% overall increase-from 31.3% to 40.2%-in psychiatric ED visits per 1000 young persons between 2011 and 2015, with the largest increases observed in teenagers (54%), African Americans (53%), and Hispanic (91%) patients.¹ Suicide-related visits among teenagers increased by 2.5-fold, the report continues. Although roughly half of these ED visits were around 3 hours in length, just 16% of patients were seen by a mental health professional during that time, the researchers add.

Luther Kalb, PhD, a researcher at the Kennedy Krieger Institute at the Johns Hopkins University Bloomberg School of Public Health in Baltimore, Maryland, and lead author of the study, says the report highlights the need for mental health services in EDs.

“It was surprising at how common psychiatric ED visits were in 2015-1 in 10 ED visits was for mental health purposes,” Kalb says. “I was also surprised at how long these visits were-1 in 5 was more than 6 hours long-and how few youths saw a mental health professional-only 1 in 6. This was pretty shocking.”

EDs are in crisis mode

The report was compiled using data from the 2011-2015 National Hospital Ambulatory Medical Care Survey, a national survey of ED visits across the United States, to identify trends in ED visits among young persons aged 6 to 24 years.

Emergency department visits for mental health have been increasing for some time and previously have been estimated at around 5% to 7% of all pediatric ED visits, although these figures were believed to have been underreported. More than 1 in 10 adolescents suffer from serious psychiatric disorders, and many never receive treatment, the report notes. Emergency departments are not staffed with adequate mental health resources to handle these crises and are increasingly becoming overwhelmed, the researchers found.

“Using the ED as a psychiatric crisis center needs to change,” Kalb says. “We need to look at expanding other crisis treatment options such as walk-in crisis care centers, telepsychiatry, and mobile crisis treatment. We also need to study these interventions as well to make sure they are evidence based. 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 ED is a really a medical, not a mental health, treatment setting.”

For pediatricians, this may mean increased mental health awareness and screening in the outpatient setting.

“Depression, and mental health in general, is a pressing issue among youth today. The increasing suicide and opioid epidemics are having a devastating impact on youth, which is supported by our study showing the increasing trends of these visits in the ED,” Kalb says. “Pediatricians are finding themselves at the front lines and they need to make sure they’re well trained to engage in pediatric mental health. They also need to be in close contact with community mental health services to provide the needed referrals.”

Research shows that even with better outpatient intervention, visits to the ED during a mental health crisis will continue, the report notes. Kalb says he hopes, however, that the report will help to improve prevention strategies and lessen the burden on EDs.

“I hope the report spurs greater resources for children, families, clinicians, and hospitals. We need to increase capacity in the system, whether it’s expanding clinical expertise, funding new centers, or providing in-home or online supports,” Kalb says. “I hope this study will highlight what is going on the community, with the goal of getting to children and families before they are in crisis. At the end of the day, I hope this work leads to better quality of life for youth, their families, and the communities that care for them.”

References:

1. Kalb LG, Stapp EK, Ballard ED, Holingue C, Keefer A, Riley A. Trends in psychiatric emergency department visits among youth and young adults in the US. Pediatrics. 2019;143(4):e20182192.