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• Posted December 28, 2022

Long Stays Common for Kids Who Visit ERs in Mental Health Crisis

It's a scenario no parent would ever want to witness: Their child suffers a mental health crisis and is taken to the emergency room, only to have to wait 12 hours or more for the right medical care.

Sadly, it is what 1 in 5 of these young patients now face, new research finds.

"For kids with mental health conditions, long waits in the emergency department have been a compounding problem for decades," said lead researcher Dr. Alexander Janke, a visiting research scientist at Yale University Medical School in New Haven, Conn.

The long waits are a symptom of a larger problem: Between numerous bottlenecks in the mental health care system and poor access to counseling services in settings like clinics and schools, "the system we have built to take care of some of our most vulnerable children is not adequately resourced," Janke said.

For the study, Janke and his colleagues turned to data from the American College of Emergency Physicians Clinical Emergency Data Registry. The researchers looked specifically at 107 emergency departments in 29 states from January 2020 through December 2021.

The investigators found that the rate of visits where a child stayed longer than 24 hours more than doubled in some months during the pandemic.

According to the report, kids who remained in the emergency department for more than 24 hours accounted for 7% of pediatric mental health visits. Some of the most common emergencies included attempted suicide, self-harm and depression.

These increased lengths of stay contribute to the problem professionals call "boarding," which is extended stays in emergency departments as patients wait for additional care or transfer, the study authors noted.

"We must support community emergency departments, struggling against unprecedented challenges of boarding and crowding, to help take care of these kids," Janke said. "That means creating real-time local data dashboards that can better describe which communities are most impacted, and better integrate local mental health resources into emergency care."

Policymakers and the public must come to understand that emergency departments struggling with crowding represent a failure of the health care system, he said. "We must bring more resources to the emergency departments where these children are in crisis, to ensure they get the care they need," Janke said.

The findings were published online recently in the Journal of the American College of Emergency Physicians Open.

Importantly, this study focused on community emergency departments, where most children in the United States receive their emergency care, said Dr. Jennifer Hoffmann, an attending physician in the division of emergency medicine at the Ann & Robert H. Lurie Children's Hospital of Chicago.

"Increasing visit lengths indicate a lack of definitive access to community and higher levels of psychiatric care for children," Hoffmann said. "The current youth mental health crisis is a national emergency. Swift action is needed to support youth mental health."

Significant federal investments are needed to bolster the pediatric mental health workforce and ensure that children have access to mental health services across the continuum of care, from community-based services to inpatient psychiatric care, she added.

"Solutions include improving access to telemedicine, expanding school-based mental health services and supporting mental health care delivery within pediatric primary care offices," Hoffmann said. "More attention is needed to prevention, identification and early treatment of mental health conditions before they reach the point of crisis requiring an emergency visit."

More information

For more on children's mental health, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: Alexander Janke, MD, visiting research scientist, Yale University Medical School, New Haven, Conn.; Jennifer Hoffmann, MD, attending physician, division of emergency medicine, Ann & Robert H. Lurie Children's Hospital of Chicago; Journal of the American College of Emergency Physicians Open, Dec. 20, 2022, online