Children being treated in the emergency department (ED) for mental health concerns
are staying longer than they did a decade ago, highlighting the need for better access
Researchers analyzed data from the National Hospital Ambulatory Medical Care Survey
on children ages 6-17 years and reported their findings in “Prolonged Emergency Department
Length of Stay for U.S. Pediatric Mental Health Visits (2005-2015),” (Nash KA, et
al. Pediatrics. April 5, 2021, https://doi.org/10.1542/peds.2020-030692).
The team found about 25% of the mental health ED visits in 2015 lasted more than six
hours, up from 16% in 2005. About 13% of the mental health ED visits in 2015 lasted
more than 12 hours, up from 5% a decade prior. Length of stay for non-mental health
visits were stable during this time.
“Mental health care for children is expensive and suboptimal reimbursement limits
incentives to expand services,” authors wrote. “There continues to be a dearth of
child psychiatrists and community supports. EDs struggle to safely discharge children
who present in crisis to appropriate care settings in light of limited services and
poor coverage, which in turn leads to prolonged ED LOS (length of stay).”
Racism, language barriers and immigration status may compound these issues for Hispanic
children, who were almost three times as likely as White children to be in the ED
for more than 12 hours.
Authors called for state and federal policy changes to improve coverage of mental
health services and increase the number of specialists. In addition, they recommended
EDs ensure around-the-clock access to trained pediatric mental health providers, provide
additional training to ED staff and consider having a designated space in the ED for
children with mental health concerns.
Authors of a related commentary noted the COVID-19 pandemic has taken an additional toll on mental health, and Black
and Hispanic families may suffer disproportionately. They suggested additional funding
to increase the availability of mental health crisis services.
“Strengthening pediatric community mental health resources, including crisis response
services, would facilitate access to high quality mental healthcare outside of the
ED,” they wrote, “and centering members of marginalized communities in healthcare
services planning will ensure access to mental health care for all children.”