Nearly a quarter of pediatric mental health visits to hospital emergency departments in the U.S. took more than six hours as of 2015. This is up from about 16% in 2005, according to a report published this month by the journal Pediatrics. What’s more, the research also showed that Hispanic children faced nearly three times the likelihood of being stuck in the emergency room for more than 12 hours when needing mental health care. These findings come amid a spike in children and teens experiencing mental health emergencies during the pandemic.
Delays in Emergency Pediatric Mental Health Care
For the study, a team of researchers analyzed data on nearly 150 million pediatric emergency department visits across the country between 2005 and 2015. The data came from the National Hospital Ambulatory Medical Care Survey, which aims to provide objective, reliable information on emergency care at hospitals in the U.S. Nearly 7.3 million of those visits (or 4.9%) were related solely to mental health, or included both mental and physical health diagnoses. The researchers only looked at data on emergency department visits for people between 6 and 17 years old. The results showed that mental health visits had higher rates of prolonged lengths of stay than other types of visits to the emergency room. More than 21% of mental health stays lasted more than 6 hours, compared with fewer than 5% of non-mental health visits to the emergency department, while stays of more than 12 hours occurred in 7.7 of mental health visits versus just 1.2% of other visits. “This is not surprising at all. It’s pretty consistent with what we’re seeing across the board in both medical emergency departments and psychiatric emergency departments,” says Keith R. Stowell, MD, MSPH, associate professor of psychiatry at Robert Wood Johnson Medical School and chief medical officer for Rutgers University Behavioral Health Care in New Jersey. “It speaks primarily to the lack of resources to serve this population.” The data also showed that the length of time children spent in emergency departments for mental health needs increased between 2005 and 2015. The rate of pediatric emergency mental health visits that lasted more than 6 hours climbed from 16.3% in 2005-2006 to 24.6% in 2014-2015, while rates of visits that took more than 12 hours more than doubled from 5.3% of 12.7%. “[That may be because] mental health awareness has increased quite significantly from 2005 to the present and that awareness triggers more need for mental health services, and perhaps the resources have not come along as far,” says Mayra Mendez, PhD, LMFT, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California. She adds: “There is limited access to child mental health specialists. Not just anybody can treat a child, and the delay in finding a specialist can prevent the treatment avenue from being accessed quickly.” The researchers also found an extreme disparity in prolonged stays for emergency mental health care among Hispanic children, who faced about 2.7 times the rate of 12-hour visits compared with White children. Both the study authors and outside experts say the disparity may have to do with systemic issues surrounding minority access to healthcare. “Are there issues with language barriers? Are there concerns related to racism and discrimination that would prevent them from getting care? Are there issues related to insurance status, or because they may be undocumented immigrants or children of undocumented immigrants?” asks Dr. Stowell. “I think there’s a number of theories on why that’s the case, but we don’t have the data to show what it is at this point.”
Long Waits Damage Mental Health
The atmosphere at hospital emergency departments usually isn’t ideal for addressing mental health needs. “It’s not a fun place to be. It’s an uncomfortable environment, and I think it can be scary and anxiety-provoking,” says Dr. Stowell. “Especially with COVID, visitors or family can’t always come in, so kids can be away from their support system, and it can be pretty isolating.” Spending long periods of time in that environment while living through a mental health emergency, such as a suicide attempt, severe depression, or aggression toward self or others, could make symptoms even worse for kids. “The more time that goes by without attention, the deeper and more intense the mental health stress grows, and the more entrenched you get,” warns Dr. Mendez. That, in turn, could make it even more difficult for doctors to make a proper diagnosis and get children the help they need. “There’s distortion in how the problem is presenting. That distortion challenges the clarity of what’s going on, and that delay prevents accurate assessment, diagnosing, and treatment. It’s a big problem,” says Dr. Mendez. And in some cases, a very long wait could lead to some children leaving the emergency room without ever seeing a mental healthcare provider.
Urgent Need to Address the Problem
Unfortunately, we may not see improvements to the system anytime soon. While the most recent data used in the study is about six years old, it’s likely that things have only gotten worse since then. “Even before COVID, we were seeing an increase in mental health needs among children and adolescents. Add COVID into the mix and the isolation, anxiety, depressive symptoms, and other concerns that go along with it, I have no reason to think there’s been a marked change or improvement,” says Dr. Stowell. A report released by the Centers for Disease Control and Prevention (CDC) in November 2020 found that mental health-related visits to emergency departments climbed 24% for kids ages 5 to 11 and 31% for adolescents ages 12 to 17 in April through October of that year, compared with the same period in 2019. With the pandemic stretching resources even thinner, experts say there’s an urgent need for governments and hospitals to provide more mental health resources for children. “A crisis response team that’s available to the emergency room would also be great,” says Dr. Mendez. “The other big thing is knowing what the patient’s mental health coverage is, so they can refer them to mental health resources available through their insurance.” However, a deficit of pediatric mental healthcare specialists, along with inadequate payments from public and private health insurance for mental health care, could make it difficult for hospitals to beef up these services. “Unfortunately mental health care is not reimbursed particularly well, so systems of care are more likely to develop services that pay better. And even if a facility wants to open up a new outpatient clinic or a new inpatient child unit, it’s hard to find psychiatric nurses, psychologists, and therapists to staff these programs,” says Dr. Stowell. “There are a whole bunch of challenges that play a role in this.” Overall, the latest research highlights the growing need for improvements in emergency care for kids and teens facing mental health emergencies. “The takeaway is that access to mental healthcare for children and adolescents continues to be extremely challenging,” says Dr. Stowell. “We need a systemwide response to help improve the services that are available to this population, which has considerable need. We need to look at all the components that play a role in it, from coming up with programs to providing support and a funding infrastructure to make those changes.” Knowing what to expect at the emergency department can help you make an informed decision on accessing quality care if your child is experiencing a mental health concern. Finding ways to get them adequate care outside of an emergency department setting could help them avoid spending many hours in a stressful environment. However, long stays in emergency departments should not dissuade you from seeking urgent care for your child in a crisis situation.
