When a child is experiencing a mental health crisis, families increasingly turn to the emergency department for help. While hospitals across Illinois are making progress in caring for these children, they face significant challenges, especially limited access to specialists and long waits for psychiatric care, according to a survey of Illinois emergency departments published in the Journal of American College of Emergency Physicians Open. The surveyed emergency departments also proposed practical solutions, such as investments in mental health staffing, therapeutic activities, and real-time bed tracking for better coordination of psychiatric resources.
Hospitals told us what they need – better access to mental health professionals, tools to support children while they wait, and systems that make it easier to connect children with the right level of care. Our findings provide a roadmap for improving pediatric mental health emergency care."
Jennifer Hoffmann, MD, MS, lead author, emergency medicine physician at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine
The study included 65 emergency departments across the state that participate in the Illinois Pediatric Facility Recognition Program, which supports pediatric emergency readiness based on core requirements. Established in 1998, the Illinois program was one of the earliest in the country to provide a state regulatory designation for pediatric emergency care. About half of the emergency departments in Illinois participate. As of 2023, 23 states have similar pediatric recognition programs.
In the study, nearly two out of three responding emergency departments were in hospitals without a pediatric inpatient unit, highlighting that many children receive mental health emergency care in hospitals that do not specialize in pediatrics. About one in five responding emergency departments were in critical access hospitals, representing communities where access to pediatric mental health specialists may be especially challenging.
Dr. Hoffmann and colleagues found that only 56% of emergency departments reported having mental health professionals available onsite. Another 44% reported using telemental health services.
"We identified that a key gap in emergency care was timely access to evaluation by a mental health professional, particularly those with pediatric-specific expertise," said Dr. Hoffmann.
One of the top barriers to optimal care of children with behavioral and mental health concerns, identified by 81% of emergency departments, was limited availability of services following the visit, which could include ongoing care in the community or psychiatric hospitalization. This often results in prolonged waits in the emergency department, which was identified by 70% of respondents as a major challenge. More than three-quarters of emergency departments reported that, within the past year, at least one child waited for over three days to be matched with the needed psychiatric care.
"Children experiencing a mental health crisis should not have to wait days in an emergency department for the care they need. We would never allow a child with a broken leg to wait three days for surgery. We should apply those same standards to children with mental health needs," said Dr. Hoffmann.
Emergency departments varied in their implementation of best practices to care for children at risk for suicide. Screening children for suicide risk regardless of the reason for their visit was reported by 88% of emergency departments. However, only about half (56%) consistently followed recommended steps to prepare families to keep children safe from self-harm at home.
"It is encouraging that most emergency departments are screening children for suicide risk," said Dr. Hoffmann. "The next challenge will be making sure that families leave the emergency department with a clear plan for keeping their child safe and getting help."
Emergency departments highlighted specific resources that could immediately improve the experience and quality of care for children and families:
- 82% wanted safe activities and games to help children cope while waiting
- 73% wanted real-time information about available pediatric psychiatric beds across the state
- 72% wanted a case manager to support families in connecting to follow-up care
- 65% wanted a mechanism to escalate cases in which staff had difficulty finding an appropriate placement for the child
"These survey findings highlight important differences in pediatric behavioral health care processes and resources across emergency departments, along with shared barriers and clear opportunities for improvement. They point to the need for stronger coordination and greater consistency across Illinois' pediatric mental health care system," said Michelle M. Barnes, MD, FAAP, President of the Illinois Chapter of the American Academy of Pediatrics. "The Illinois Chapter of the American Academy of Pediatrics is committed to advancing efforts that strengthen mental health care delivery and better support children and families across our state."
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