Pediatric mental health emergency visits often result in long waits for care

Approximately one in three pediatric mental health Emergency Department (ED) visits resulting in admission or transfer exceeded 12 hours, and over one in eight exceeded 24 hours, according to estimates based on nationally representative data from 2018 to 2022. Seven in 10 of all kids staying in the ED over 12 hours were there for suicidal thoughts or attempt, and over half for aggressive behaviors. Findings were published in the Journal of American College of Emergency Physicians.

Our study underscores significant issues with access to mental health care for children and adolescents, who often face prolonged ED stays because a psychiatric bed is not available. As the youth mental health crisis continues, we have been seeing more severe psychiatric conditions in the ED. Most of these kids seek emergency care at adult hospitals, which often have more limited pediatric resources compared to children's hospitals and might not be prepared to provide the necessary supports."

Jennifer Hoffmann, MD, MS, Lead Author, Behavioral Health Medical Director, Emergency Medicine at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine

The study sample was representative of all pediatric ED visits for mental health concerns in the U.S., with only 1 percent occurring at children's hospitals. Dr. Hoffmann pointed out that given this situation, continued funding is essential for the Emergency Medical Services for Children (EMSC), a federal program that provides training to non-pediatric hospitals across the country in the efficient and effective care for youth in the ED.

Dr. Hoffmann and colleagues evaluated records that represented 5.9 million mental health ED visits by children 5-17 years old in a four-year period. An estimated 1.4 million of these visits resulted in admission or transfer.

The study found that youth with public insurance were more likely to remain in the ED for more than 12 hours waiting for a psychiatric bed, which highlights inequities in accessing mental health services.

"Differences in reimbursement rates for psychiatric services, which are often lower with public relative to private insurance, may contribute to inequities in care access," said Dr. Hoffmann.

In addition to the needed improvements in Medicaid reimbursement rates for pediatric mental health care and sustained funding for EMSC, Dr. Hoffmann suggested several potential solutions to increase mental health care access for youth. These include greater use of telehealth, school-based mental health services and integrating mental health care into primary care. She also mentioned the emerging psychiatric urgent care clinics, as well as free-standing psychiatric EDs, which might help respond to the growing demand for these services in children and adolescents.

The study was funded by the Pediatric Pandemic Network.