Çchildren taken to the emergency room for mental health problems are more likely to be stuck there for long periods than a decade ago, according to new research. Hispanic children are almost three times more likely than white children to experience these delays in care.
“Every minute, every hour, every day a child with mental health [needs] emergency room spending is a delay in the care they really need, ”said Katherine Nash, author of the study, published Monday in the journal Pediatrics.
Nash and his team at Yale University analyzed data from the 2005-2015 national survey, with a focus on the patient’s length of stay in the emergency room. They found that visit rates that lasted more than six hours for pediatric mental health problems increased from about 16% to almost a quarter of visits. Stays longer than 12 hours have increased from 5% to almost 13%.
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Although researchers are not sure what is causing the delays, they believe they are a sign of worsening access to adequate pediatric mental health care.
Emergency departments are not designed for mental health emergencies and, in most hospitals, are also not designed for children. They can be loud, chaotic and a traumatic experience, Nash said. Still, they often serve as an entry point for more specialized care for children with mental health problems. The number of adolescents in a mental health crisis has increased over the years, with a particularly intense volume during the pandemic.
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With this wave, the emergency room has become more of a bottleneck, as children are forced to wait for understaffed pediatric departments to send a consultant doctor or for adults to find an external facility equipped to deal with comorbidities or health factors. risk exclusive to a child. Only 16% of children who came to the emergency room for a mental health consultation have ever seen a mental health professional, according to the study.
When children are identified as at high risk of causing harm to themselves or another person, they cannot return home safely. These children may have to wait in the emergency room for hours or even days until they can see a specialist or be transferred to an appropriate psychiatric center.
“We would never let a child with diabetes wait a week to see an endocrinologist and start taking insulin,” said Lois Lee, a doctor at Boston Children’s Hospital who was not involved in the study. “However, we are letting these children wait a week to receive the care they need.”
Children who exhibit violent or dangerous behavior need experienced professionals who can keep them safe and provide medication when appropriate. Lee says he saw children waiting for mental health care in the emergency room for days on end.
In general emergency rooms, children awaiting mental health treatment also delay the care of other emergency patients who need a bed.
“Using the emergency department is a precious resource,” said Polina Krass, a physician at Children’s Hospital in Philadelphia, co-author of a comment on the study.
For non-white Hispanic children, access barriers appear to be even greater, with three times greater chances of prolonged stay. This disparity was not present for other racial groups, which leads experts to question whether language barriers contribute to delays in attendance.
“The implication of this work is that there are situations where we can provide better quality transitions for definitive treatment,” said Krass.
At least part of the solution to these service delays may be outside the emergency room, Krass said. More options are needed for children with mental illness too acute to wait weeks to see a therapist, but also not so urgent that they need to spend the night in the hospital. The latest pandemic stimulus package approved by Congress has provided funds for states to develop their own crisis response systems as a potential alternative for anyone calling 911. This is in addition to the new national three-digit number, 988 , which connects to crisis centers for mental health emergencies that was sanctioned last year.
More descriptive research is needed on the causes behind prolonged stays in emergency rooms for children in a mental health crisis in order to create more solutions, Krass said.
“Because it is an administrative database, you don’t really go into the details of the real experience of these children, teenagers and families,” said Lee.
Nash hopes to continue research on the length of hospital stay for pediatric patients and to take a closer look at interventions that have not yet been tested in emergency departments.
“A mentor once told me to study what makes him angry,” said Nash. “And this is a lot.”