A recent study has revealed alarming statistics regarding children experiencing mental health crises who visit emergency departments (EDs). These children often find themselves stuck in the ED for extended periods, sometimes lasting several days. The research indicates that approximately one in ten children enrolled in Medicaid who visit emergency departments for mental health emergencies end up being boarded for three days or longer. This issue raises serious concerns about the availability and adequacy of mental health care for children across the country.
The study, published in JAMA Health Forum, identifies the most prevalent mental health crises leading to prolonged stays in the emergency department as depressive disorders and suicidal thoughts and attempts. According to John McConnell, the lead author of the study and director of the Center for Health Systems Effectiveness at Oregon Health and Science University, the scenario is quite concerning. "When a child arrives at an emergency department with a mental health condition, about one in ten times, they end up staying for three days or longer," he explains.
The research highlights significant disparities across different states. In some regions, such as North Carolina, Florida, and Maine, as many as 25% of mental health visits result in children boarding in the ED for periods ranging from three to seven days. Dr. Jennifer Havens, chair of the Department of Child and Adolescent Psychiatry at the NYU Grossman School of Medicine, emphasizes the importance of this data. "Although the findings may not be surprising, having concrete data allows us to understand the scope of the issue nationwide," she notes.
Boarding in emergency departments has become an escalating problem over the years, particularly for pediatric mental health cases. Dr. Rebecca Marshall, an associate professor of child and adolescent psychiatry at OHSU, points out that the nationwide children's behavioral health crisis has outpaced the ability of states to adequately respond. "We have really struggled to build capacity over time to increase the number of inpatient beds," she states. Consequently, children requiring inpatient psychiatric care may face long waits until a bed becomes available.
The lack of available psychiatric beds for children is particularly alarming. For instance, Oregon has only 38 beds designated for the highest need pediatric psychiatric cases and fewer than 200 residential beds for long-term treatment. This significant shortage highlights the broader issue of inadequate access to mental health services, both inpatient and outpatient. Dr. Havens reiterates, "There's an enormous problem across the country with a lack of access to mental health services."
Access to adequate outpatient services is crucial in preventing children from reaching a crisis point. Without sufficient mental health care options, families often resort to taking their child to an emergency room during a mental health crisis. Unfortunately, as Dr. Marshall explains, "When families arrive at the ED, they frequently find that immediate care is not available." Many emergency departments lack child and adolescent psychiatrists, reflecting a longstanding underinvestment in mental health resources for children.
When children in mental health crises are forced to stay in emergency departments for extended periods, their conditions can deteriorate. Most of these children are confined to small, often windowless rooms, where they are unable to leave, exercise, or interact with peers. Dr. Marshall emphasizes, "The absence of therapeutic activities, which are typically available in inpatient units, exacerbates their situation." This lack of engagement and proper care can significantly hinder their development and recovery.
The findings of this study shed light on a critical issue within the pediatric mental health landscape. With a significant number of children facing long waits in emergency departments, it is imperative that health systems and policymakers prioritize increasing access to mental health services and resources. Addressing these challenges is essential for ensuring that children receive the timely care they need to navigate their mental health crises effectively.
