Racial Disparities in Pediatric Psychiatric Emergencies: A Health Systems Approach

Abstract

Less than half of African American youth with severe mental disorders receive psychiatric care. When they do receive care, African American youth use the Emergency Department at higher rates than whites. We examine whether rapid expansion of primary mental health care at Community Health Centers reduces Emergency Department visits for psychiatric care especially among African American youth. Through four studies, we examine (1) the impact of mental health service capacity on the disparity of psychiatric care among African American youth; (2) how Community Health Center mental health visits vary with repeat psychiatric emergency visits; (3) the county-level drivers of the expansion of Community Health Centers; and (4) how Community Health Center expansion affects overall psychiatric emergency care. Results indicate that increased continuity of mental health care at Community Health Centers corresponds with a reduction in racial disparities in youth psychiatric ED visits. In addition, an increase in Community Health Center capacity varies inversely with repeated psychiatric Emergency Department visits and inversely with psychiatric Emergency Department visits overall. And finally, results show an increase in Community Health Center mental health services among counties with greater poverty, lower physician availability, and higher percentage of uninsured. Our studies indicate that expansion of federally-funded primary mental health services affects the overall system of emergency psychiatric care. However, this expansion does not appear to dramatically reduce racial/ethnic disparities in psychiatric emergency department visits.

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

“…A systematic review of randomized controlled trials examined the impact on ED utilization of mental health care provided in outpatient, community, school, and primary care settings and concluded that there is limited evidence to suggest an effect (Kirkland et al, 2018 ). A related study found that increasing access among African Americans to community health center services produced a statistically significant, but practically insignificant reduction in racial and ethnic disparities in psychiatric ED visits (Das et al, 2020 ).…”