Youth mental health crisis leads to prolonged emergency room stays

America's youth mental health crisis has escalated to the point that thousands of children primarily suffering from suicide-related behaviors and depression are stuck in hospital emergency rooms for three days or more, according to new research from Oregon Health & Science University.

The study, published today in the journal JAMA Health Forum, examined Medicaid claims data from 2022.

Among 255,000 hospital emergency department visits for mental health conditions involving Medicaid-enrolled kids, more than 1 in 10 visits resulted in children being "boarded" - kept in the emergency department because an acute care bed is not available in the hospital - for three to seven days.

"In a perfect world, boarding wouldn't happen at all," said lead author John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness.

In the case of young patients in mental health crisis, there may not be an available hospital bed or it may not be possible to discharge them home or to a more appropriate residential facility focused on behavioral health.

If you're a parent and your child is having a crisis, you may go to the emergency department and then ideally find a more suitable place to get care after that. Unfortunately, this study reveals that there is often no place to send them."

John McConnell, Ph.D., Director, OHSU Center for Health Systems Effectiveness

The problem has gotten more pronounced in recent years as capacity for inpatient treatment has failed to keep up with the growing population of kids in crisis, experts say.

For example, the number of kids requiring a psychiatric consultation in the emergency department of OHSU Doernbecher Children's Hospital has tripled from 150 in 2016 to 453 during the last calendar year, said Rebecca Marshall, M.D., an associate professor of psychiatry in the OHSU School of Medicine who directs the pediatric psychiatry consult service.

Boarding kids in the emergency department has a "huge impact" on children, their families and hospital staff, she said.

"Nurses and doctors who go into pediatric care do so because they like kids and want to see them doing better," said Marshall, who wasn't involved in the study. "When you have a child languishing in the emergency department not able to get the care they need, their condition can get worse. It's demoralizing and overwhelming, especially when you're trying to juggle a lot of other kids who also need care."

McConnell, a professor of emergency medicine in the OHSU School of Medicine, said the situation underscores the shortage of appropriate care in Oregon and nationwide.

"There's no single entity responsible for the mental health of Medicaid-enrolled people," he said. "Long term, we have to look at whether we have the right mix across the continuum of care for young patients in crisis and to make sure they're supported with Medicaid and other insurance payers."

In addition to McConnell, co-authors include Thomas Meath, M.P.H., of the OHSU Center for Health Systems Effectiveness, and Lindsay Overhage, B.A., who conducted the research at OHSU and is now an M.D./Ph.D. student at Harvard Medical School.