CChildren taken to the emergency room after mental health care are likely to stay there longer than they were a decade ago, according to new research. Spanish 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 care [needs] spending on the ED is a delay in the care they actually need, ‘Katherine Nash, author of the study, published Monday in the journal Pediatrics.
Nash and her team at Yale University analyzed the 2005-2015 national surveys, focusing on the duration of the patient in the emergency. They found that the number of visits lasting longer than six hours for mental health in children increased from about 16% to almost a full quarter of the visits. Stays longer than 12 hours increased from 5% to almost 13%.
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Although researchers are not sure what is causing the delays, they believe it is a sign of access to adequate mental health care for children.
Emergency wards are not designed for mental health emergencies, nor are they designed for children in most hospitals. They can be harsh, chaotic and a traumatic experience, Nash said. Yet they often serve as an access point to more specialized care for children who have a mental health problem. The number of adolescents experiencing mental health crises has increased over the years, with a particularly intense volume during the pandemic.
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Through this upsurge, the emergency has become more of a bottleneck, as children have to be forced to wait for subordinate pediatric wards to send a doctor, or adults have to find an outpatient facility equipped with the child’s unique comorbidities or risk factors to handle. . Only 16% of children who came to the emergency room after a visit for mental health have ever seen a service provider, according to the study.
If children are identified as at high risk of harming themselves or anyone else, they may not be able to return home safely. These children may have to wait hours or even days in the emergency room until they can see a specialist or be transferred to an appropriate psychiatric institution.
“We will never allow a child with diabetes to wait a week to visit an endocrinologist and start their insulin,” said Lois Lee, a doctor at Boston Children’s Hospital who was not involved in the study. , said. “However, we let these children wait a week to get the care they need.”
Children who engage in violent or dangerous behavior need experienced providers who can keep them safe and provide medication if needed. Lee says she has seen children wait for mental health care in the emergency room for days.
In general emergency departments, children awaiting treatment for mental health also delay the care of other emergency patients in need of bed.
“The use of emergency departments is a precious resource,” said Polina Krass, a physician at Philadelphia Children’s Hospital, who co-authored a comment on the study.
For non-white Spanish children, the barriers to entry seem even higher, with three times the chance for a longer stay. This difference was not present in other racial groups, which makes experts doubt whether language barriers contribute to the delays in care.
“The implication of this work is that there are situations in which we can provide transitions of better quality to definitive care,” Krass said.
At least part of the solution to these delays in care may lie outside the emergency, Krass said. More options are needed for children who experience mental illnesses that are too acute to wait weeks to visit a therapist, but also not so urgent that they have to be in the hospital at night. The most recent pandemic stimulus package adopted by Congress has allocated funds for states to develop their own crisis response systems as a possible alternative for all who 911. Call it above and beyond the new national three-digit number, 988, which joins crisis centers. for mental health emergencies signed last year.
More descriptive research is needed into the causes behind the extended emergency room stay for children in a mental health crisis to create more solutions, Krass said.
“Since it’s an administrative database, you do not really get into the funny details of the true experience of these children and teenagers and families,” Lee said.
Nash hopes to continue research into the length of stay for pediatric patients and to take a closer look at interventions yet to be tested in the emergency departments.
“A mentor once told me to study what makes you angry,” Nash said. “And it’s very much that.”