ER visits for pediatric mental health emergencies are soaring

Editor’s note: This is the first of two parts.

Jane (not a real patient), a 15 year old sophomore was sent to the school nurse during second period because she was falling asleep in class. She admitted to the school nurse that prior to coming to school, she overdosed on a mixture of Tylenol, Motrin, Benadryl, and Adderall. With this information, the school nurse called an ambulance and she was transported to the Emergency Department (ED). She was immediately placed on one-to-one supervision. Her ED evaluation showed that she was stable in spite of the overdose, and she was medically cleared.

The crisis social worker, who was asked to evaluate her, finally saw her after she had been in the ED for four hours. She was deemed suicidal and her team of medical providers agreed she should be transferred to an inpatient psychiatric facility. The crisis social worker spent the next 1.5 hours calling all the area psychiatric facilities which accept adolescents, only to find out that there were no beds available. After spending more than 8 hours in the ED, she was admitted to the pediatric inpatient ward while waiting for availability of an adolescent psychiatric bed.

This scenario has become an almost daily occurrence among EDs that care for children. This trend of increasing pediatric mental health visits to hospital emergency departments is underscored in a study published last month in the Journal of Pediatrics.

The investigators evaluated all visits to a busy British Columbia, Canada children's hospital ED with a chief complaint or discharge diagnosis related to mental health from 2002 to 2012. During this 10 year period, mental health visits increased by 47 percent compared with an increase of 9 percent in total visits. Mental health visits accounted for 1.9 percent of the total 431,797. The mean age at presentation was 13.2 years and 52 percent of the patients were girls. About a third of the visits (31 to 37 percent annually) were return visits, with about 12 percent occurring within 30 days of the previous visit. The mean ED length of stay was significantly longer for mental health versus non-mental health visits (279 versus 183 minutes).

Over the study period, there was a shift in the most common mental health diagnoses. In the earlier years, substance abuse related disorder was most common, accounting for about one fifth of the mental health visits. By 2012, the top two mental health diagnoses were mood and anxiety disorders, and suicidal ideation.

As a parent or caregiver, what does this mean for you if your child has a mental health emergency?

It is crucial for parents and caregivers to recognize if a child is experiencing a mental health emergency. Take any changes in the child's mood or personality, sleeping and eating patterns, socialization, and school performance seriously. Listen and pay close attention to concerns from people with whom your child regularly interacts. These include siblings, friends, teammates, classmates, teachers, and school counselors.

Any communication regarding thoughts of harming one's self or others, whether spoken, written, texted, tweeted, or shared in social media should prompt a crisis evaluation. The same holds for anger or aggression which result in significant disruption at home or school, property damage, or any injury to the child or others.

If the child is seeing a mental health professional (such as a therapist or psychiatrist), the best course of action is to connect with the professional first, whether in person or by telephone, and seek his or her advice.  

In addition, the Mental Health Association of Southeastern Pennsylvania has an Information and Referral Department, which can provide you with information about mental health services in the five-county Southeastern Pennsylvania region, including Bucks, Chester, Delaware, Montgomery and Philadelphia counties. The Information and Referral Director can be reached at 267-507-3843 or iandr@mhasp.org; the Information and Referral Project Coordinator can be reached at 267-507-3843 or iandr@mhasp.org. Both can be called toll-free at 800-688-4226, ext. 3843.

If you are seeking help from outside of Southeastern Pennsylvania, the National Institute of Mental Health has resources here.

In my next post, I will talk about pediatric mental health emergencies in US hospitals and what needs to be done to address this issue.


 

Have a question for the Healthy Kids panel? Ask it here. Read more from the Healthy Kids blog »