Over a million emergency room (ER) visits are attributed annually to children and adolescents with a mental health disorder diagnosis.
That’s according to a new study by the CDC, which builds on previous research demonstrating the worsening mental health crisis among children and adolescents.
The emergency department has become the first response for immediate mental health needs for many children and adolescents, the study’s authors pointed out, due to the decreasing number of psychiatric care facilities nationwide and the inaccessibility of outpatient services.
The study analyzed data from a nationally representative survey conducted by the National Center for Health Statistics to determine that the rates of mental health-related ER visits among children differed based on demographics and mental health status between 2018 and 2021.
To ensure that data for 2020 was not skewed because of the COVID-19 pandemic, researchers compared mental health ER visit rates with other years and found no statistically significant difference.
The study’s authors noted that the number of pediatric ER visits for mental health disorders has increased year-over-year by a much higher rate than all other types of ER visits. Mental health ER visits increased by 8% annually from 2015 to 2020, while all other visits increased by only 1.5% annually.
“This trend continues to be a concern, but it is not a surprise,” Rola Aamar, principal of behavioral health solutions at Relias, told Behavioral Health Business. “Healthcare providers and researchers have been focused on the increasing numbers of emergency department and hospital visits for several years now, specifically calling for increased access to services and addressing gaps in access to care.”
Cary, North Carolina-based Relias provides workforce enablement solutions that work with more than 11,000 health care and human service organizations.
Demographics matter within mental health-related ER visits, the study found.
The study found that adolescents visited the ER more often than children. This may be because the most common mental disorders, like depression, develop during adolescence and because those disorders with an earlier onset, like ADHD, may remain undiagnosed throughout childhood.
Girls make up more mental health ER visits than boys, the study found. That stands in contrast to non-mental health-related visits, for which no difference between sexes exists. Visit rates per 1,000 children and adolescents were 16.1 for girls, compared to 12.1 for boys.
Researchers found that there is a stark difference between the rates of mental health-related ER visits among racial groups. Black, non-Hispanic children have an ER visit rate of 20.8, compared with a rate of 13.2 for Hispanic children and 14.4 for white children.
Some of these patterns are similar for non-mental health-related ER visits, although there was no significant difference between boys and girls for non-mental health-related ER visits.
ER visits also look different for children with mental health diagnoses.
Patients were hospitalized at 9.2% of mental health-related ER visits, compared to 4.7% of visits without mental health disorders. Children and adolescents with mental health disorders were transferred to psychiatric hospitals at 12.4% of ER visits, compared to 0.3% of visits for patients without mental health disorders.
Visits also last longer for young patients with mental health disorders. Forty-two percent of visits made by patients with mental health disorders last four hours or more, compared to 17.8% without mental health disorders.
The most common mental health disorders that children are diagnosed with in the ER are mood disorders, anxiety disorders and behavioral and emotional disorders.
Mood disorders were diagnosed at 5 ER visits per every 1,000 children and adolescents. The rate was 4.4 for anxiety disorders, 3.7 for behavioral and emotional disorders, 1.8 for substance use disorders and 1.7 for developmental disorders.
The overall ER visit rate was 14 per 1,000 children and adolescents with mental health disorders. Reducing the number of adolescent visits to the ER requires a change to the entire healthcare landscape, according to Aamar.
“Some of the systemic changes that healthcare leaders and providers alike have been advocating for include more access to mental health services, consistent reimbursement for mental health care, decreasing stigma about mental healthcare, and integrated care services,” she said.