Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Abstract

There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

Mental Health Revisits at US Pediatric Emergency Departments

“…We found that the proportion of mental health ED visits with a revisit remained stable, which may reflect that the factors associated with revisit did not change substantially during the study period, even as the pediatric mental health crisis worsened. In addition, previous literature has indicated that many children who present to the ED for mental health reasons have low acuity, so it is possible that children with low acuity, who are less likely to revisit, contributed to the stability we observed in revisit percentage. However, the significant increase in the raw number of revisits is still concerning, as increased visits overwhelm existing care models and result in worse outcomes for ED patients with and without mental health emergencies …”

Has Anything Changed in the Frequency of Emergency Department Visits and the Profile of the Adolescent Seeking Emergency Mental Care during the COVID-19 Pandemic?

“…The trend of ED presentations for psychological distress in young people appears to have increased in recent years [ 21 , 22 ], and the COVID-19 pandemic has created a new social and health scenario impacting this trend as well. From this perspective, the strength of this study consists of longitudinally evaluating the psychological discomfort of the COVID-19 pandemic-related effects on mental health in a large sample of adolescents.…”

National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

“…The observation that only 20% of pediatric mental health–related visits included evaluation by a mental health professional underscores widespread shortages in the availability of specialty ED mental health services. Additionally, while some studies have suggested that the increase in pediatric mental health–related ED visits may be due to an increase in inappropriate or less urgent mental health–related ED visits, our study demonstrates the urgency of visits has not changed.…”