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Study finds rising rate of mental health visits among youth to emergency departments

Highest jump was among 15- to 17-year-olds and more pronounced in girls. Dramatic increases in self-harm and substance use as reasons for ED visits.

CLEVELAND — While the number of pediatric emergency department (ED) visits across the nation has remained stable over the last 10 years, visits for mental health disorders have risen 60% and the rate of visits for deliberate self-harm have increased 329%.

Dr. Omar Elhaj is senior medical director for Lifestance Health psychological services.  He is seeing an increase in mental fall-out from the pandemic on children and adolescents. 

“The stay-at-home order, the inability to socialize with peers, with friends at school, the inability to go out of the house, all of that has contributed to significant distress psychologically, socially and even existentially with the kids,” he says.

In a study published in Pediatrics, Nationwide Children’s Hospital researchers looked at the number and reason for mental health-related ED visits. They also examined the geographic location of EDs and the overall number of children coming to each ED. Previous studies have shown that low pediatric volume EDs and EDs in rural settings are less prepared for all pediatric emergencies, and only one third of rural facilities have pediatric mental health policies or mental health transfer agreements.

Rachel Stanley, MD, division chief of Emergency Medicine at Nationwide Children’s and the study’s senior author said, “We would like children to go to their primary care provider or a psychiatrist, but EDs are the safety net for children with mental health disorders, and we need to be able to take care of them. Knowing why children are going to the ED is essential to making sure the EDs are prepared to treat them appropriately.”

Over the 10-year study period, most visits occurred at non-children’s EDs in both metropolitan and non-urban settings. The study looked at children 5 to 17 years old, and data is representative of all U.S. emergency departments.

Findings showed the highest jump in ED visits was among 15 -to 17-year-olds (68% increase), and while the rate grew among both males and females, it was more pronounced in girls (74% increase). Additionally, visits for substance use disorders rose by 75%, with alcohol-related disorders decreasing by nearly 40% and substance use disorders significantly increasing (over 150%). The rate of visits for deliberate self-harm increased 329%.

Further research is needed to identify solutions that will better equip all EDs with the tools, personnel and resources to better manage pediatric cases, particularly those related to mental health.

In Northeast Ohio, Rainbow Babies and Children’s Hospital, Cleveland Clinic Children’s, Akron Children’s Hospital and MetroHealth all have plans and experts in place to help a child in need.

Dr. Elhaj says parents should pay attention to changes their child may exhibit.

“If my child exhibits any change in mood or behavior including change in appetite, sleep, acting out, isolating, anything out of character it would be a good idea to reach out to my pediatrician,” Dr. Elhaj says and adds parents shouldn’t hesitate in an emergency. “Parents should not hesitate to call 911 or go to the nearest emergency room if they have any suspicions or doubts about their child's safety.”  

Universal screenings for suicidal ideation, a recent requirement of the Joint Commission, is one step to improving the quality of care for those being treated for behavioral health conditions.

Study authors say telehealth services can also provide an avenue for increasing access to behavioral health specialists who can provide screening, assist with acute interventions, and support connections to continued care within the community, thereby avoiding long distance transfers, transportation costs and delays in care.

If you or your child need immediate help because of having suicidal thoughts, go to your local emergency room, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or reach the Crisis Text Line by texting “START” to 741-741.

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