Outpatient youths routinely use ED for care during psychiatric events

Nonsuicidal, nonpsychotic children already receiving care at mental health clinics as outpatients are turning to hospital emergency departments (EDs) for care for emotional and behavioral problems.

A study of 2,900 pediatric records collected over 8 years from the Johns Hopkins Hospital Pediatric Emergency Department identified 338 youths (aged 3 to 17 years) who had an initial ED visit for a psychiatric crisis and then presented for a second such visit within 6 months. The short time between visits suggested that the underlying events were clinically related and that these youth may be at the highest emotional-behavioral risk.

Behavior problems accounted for more than half of both the initial visits and the second visits. Sixty-five percent of the youths reported their connection to an outpatient mental health provider at both visits, whereas 9% did not report a provider at either visit. However, 8% who reported a provider at the first visit did not report the connection at the second visit. Those who reported outpatient care at the second visit were 5 times more likely to have indicated a connection to outpatient care at the first visit than those who did not initially report care.

Findings that most of the repeat users demonstrated nonsuicidal, nonpsychotic behavior problems at both visits raise questions about families’ preferences for ED services over outpatient mental health providers for giving these children and teens the care they need, researchers say. They suggest that a perceived stigma associated with outpatient mental health care also may be a key factor in influencing use of the ED for psychiatric crises.

The researchers note that their study was conducted at a single institution and that their findings may not apply to all emergency care settings or patient populations.

Frosch E, Dosreis S, Maloney K. Connections to outpatient mental health care of youths with repeat emergency department visits for psychiatric crises. Psychiatr Serv. 2011;62(6):646-649.