More U.S. Teens, Kids Seeking Mental Health Care in ERs
U.S. emergency departments are seeing a surge in the number of kids and teens seeking help for mental health problems, new research warns.
Between 2011 and 2015 alone, there was a 28 percent jump in psychiatric visits among Americans between the ages of 6 and 24.
"The trends were not a surprise," said study author Luther Kalb, given that "using the emergency department for mental health reasons has been increasing for a while" among all age groups.
But why is it happening among young people?
"The rising suicide and opioid epidemics are surely a factor," given that "the ER plays a critical role in treating overdoses," he said.
"Emergency Department providers could also be more likely to detect and/or ask about pediatric mental health issues, which leads to increased detection," added Kalb, an assistant professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. "Parents may be more likely to report the child's symptoms as well.
"There is also an increase in outpatient mental health service use overall among youth in the U.S.," he noted. "This may lead to a trickle-down effect, where the provider sends the child to the [emergency department] during times of crisis."
The omnipresence of social media may also play a notable role in upping youth depression risk, Kalb acknowledged, though he stressed that "it is unknown if social media plays a role increasing psychiatric ED use."
The analysis revealed that while there had been about 31 psychiatric-related visits to the ER for every 1,000 Americans between the ages of 6 and 24 back in 2011, that figure had risen to more than 40 by 2015.
But that number shot up even higher among some groups.
For example, a roughly 54 percent increase was seen among adolescents as a whole, and black kids and young adults in particular. Among Hispanic youth, that figure rose to more than 90 percent.
What's more, visits by adolescents of all backgrounds that were specifically related to suicide risk more than doubled during the study time frame.
The investigators also observed that even though many ER visits were long (with more than half lasting at least three hours), only about 16 percent of young patients were ever seen by a mental health professional during their visit. That figure did rise to 36 percent among those seeking care for suicide or self-harm.
"It's important to note that almost all of these youth saw a physician," said Kalb. "The problem is, not all ER physicians have mental health training."
Still, he said he was "surprised at how few saw a mental health provider," though he acknowledged that many rural and community hospitals simply lack the resources.
"This could be changed by increasing mental health staff in the ER, creating special intake settings that deal just with mental health, using new technologies such as tele-psychiatry, and cross-training providers," Kalb noted.
The findings were published online March 18 in the journal Pediatrics.
Dr. Susan Duffy is a professor of emergency medicine and pediatrics at the Alpert Medical School of Brown University, and is an attending physician at Hasbro Children's Hospital in Providence, R.I. She coauthored an editorial accompanying the study.
When discussing reasons behind the findings, Duffy painted a complicated picture that variously involves the roles of poverty; violence; child and parental substance abuse; expanded insurance coverage; the influence of social media on depression, isolation and anxiety risk; information overload; and a lack of mental health training and screening expertise among primary care physicians.
Still, regardless of which reasons apply most, the overall trends are clear, she said.
"Data suggests that over 20 percent of adolescents aged 13 to 18 have experienced a debilitating mental health disorder," said Duffy. "For the past 10 years, there has been an increasing trend in children's, youth and young adult mental health visits, and increasing recognition that the resources do not meet the need for care."
So, the bottom line is that the findings "should not come as a great surprise," she said.
The U.S. National Institute of Mental Health has more on children and mental health.
SOURCES: Luther Kalb, Ph.D., assistant professor, Johns Hopkins Bloomberg School of Public Health, Baltimore; Susan Duffy, M.D., M.P.H., professor, emergency medicine and pediatrics, Alpert Medical School, Brown University, and attending physician, pediatric emergency medicine, Hasbro Children's Hospital, Providence, R.I.; March 18, 2019, Pediatrics, online
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