Mental Health ED Visits on Rise, Especially Among Younger Demographics

More children and young adults with mental health issues are seeking assistance at emergency departments (EDs) nationwide, new research concludes. The findings underscore the need for pediatric behavioral health providers.

The study, which was published in the American Journal of Emergency Medicine, was conducted by a team of researchers from the University of Southern California (USC) who assessed data compiled by the National Hospital Ambulatory Medical Care Surveys on ED visits from 2009 to 2015.

The study’s authors classified behavioral health-related ED visits to be those consisting of both behavioral health and substance use issues that constituted either a primary, secondary or tertiary health diagnosis.

Overall, ED visits for behavioral health issues rose during the study period, but the spike was especially pronounced for pediatric and young adult patients between ages 10 and 25. Growth rates for the younger group were double that of the older, with children being especially affected.

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Take those ages 10 to 14, for example. In 2009, less than 5% of that group’s ED visits were accompanied by a mental health diagnosis. But in 2015, that proportion grew to nearly 9%. Meanwhile, seniors above age 65 saw a much smaller increase, rising from 3% in 2009 to just over 4% in 2015.

For those under 18, mental health-related ED visits grew by 56%, compared to 41% for adults.

By 2015, more than 10% of all ED visits for people ages 15 to 64 were related to behavioral health. While that proportion was larger than for children ages 14 and younger, it wasn’t by much, as 9% of kids in that age group visited EDs for behavioral issues.

The time patients of all ages spent at the ED for behavioral issues also increased during the study period, from six and a half hours in 2009 to nine hours in 2015.

For ED-visiting behavioral patients of all ages who were transferred to psychiatric facilities, their length of stays increased most, going from eight hours to approximately 11. Their stays were longer than those of other behavioral patients in the ED who would eventually be discharged.

“EDs are almost universally beyond capacity so any trend in patients staying longer is a problem since it impacts our ability to have space and resources to see the next patient,” Michael Menchine, associate professor and vice chair of the emergency medicine department at USC’s Keck School of Medicine, and one of the study’s authors, said in a press release. “But, more importantly, EDs are just not great therapeutic environments for people having these kinds of crises.”

Menchine and his colleagues have received a grant from the National Institute of Health Care Management to continue their research.

“Our results indicate that the ability of the ED to discharge, admit or transfer patients with mental health diagnoses greatly impacts the care these patients receive in the ED,” Sarah Axeen, a fellow at USC’s Schaeffer Center for Health Policy & Economics, who is also one of the study’s four authors, said in a press release.

“Our goal is to directly estimate which characteristics of ED or hospital capacity account for this variation in order to improve the quality and consistency of emergency mental health care for patients,” she added.

The findings come on the heels of a study published late last year by the journal Medical Care, which indicated burdens providers face in meeting the demands of overall inpatient behavioral health care services.

That study found a substantial number of Medicare patients — about 21% — who receive inpatient hospitalization for psychiatric issues are readmitted within 30 days of being discharged.

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