Kids' ER Visits For Mental Health Problems Soar Over 10 Years

Children treated in America's emergency rooms for mental health disorders jumped 60% over a recent decade, a new study finds.

Between 2007 and 2016, visits for self-harm like suicidal thoughts and cutting soared 329% and treatment for drug abuse rose 159%, according to the study led by Charmaine Lo, from Nationwide Children's Hospital in Columbus, Ohio.

"This is happening in all emergency departments all across the country and in kids of all ages," said Lo. "And regardless of whether it's a children's hospital or a general hospital, and whether or not they're in an urban location or in a rural location."

Lo thinks that social media has put a lot more pressure on children. "Children, particularly teenagers, are feeling that. Also, there's a lot more awareness of mental health, and children know that there are resources in place for them to seek help and get help," she said.

The coronavirus pandemic is only going to make things worse, experts say.

"Although this study was conducted prior to the onset of the COVID-19 pandemic, the increase in social isolation and household stressors caused by the pandemic are likely to further worsen children's mental health," said Dr. Jennifer Hoffmann from the emergency medicine division at the Lurie Children's Hospital of Chicago.

A study from China showed that children affected by the COVID-19 pandemic had more symptoms of anxiety and depression, Hoffmann said.

The study researchers worry that emergency departments aren't equipped to handle mental health problems in children, especially small hospitals in rural areas.

"Preparation could be as simple as a screening training program for the nurses and doctors, because you don't have to be a psychologist to take care of these kids, you just need to recognize whether they're dangerous to themselves or others," said study co-author Dr. Rachel Stanley, division chief of emergency medicine at Nationwide.

"Those tools are currently available through various agencies, although they aren't being used by most of the places that are taking care of these kids," Stanley said.

For the study, Lo and her colleagues analyzed data for children aged 5 to 17 from Nationwide's emergency department databases.

The researchers found that, while the number of children seen in the emergency rooms remained stable between 2007 and 2016, visits for mental health problems increased dramatically.

Visits for alcohol problems actually fell 39%, while overall drug use visits grew substantially. This bears more investigation, the researchers said, given the opioid epidemic still raging in the United States.

The types of mental health problems reviewed included adjustment and anxiety disorders; attention-deficit, conduct, and disruptive behavior disorders; impulse control and mood disorders; and psychotic disorders like schizophrenia.

One in five US children has a mental health disorder, according to background notes. Children with mental health disorders make up about 2% to 5% of all pediatric ER visits nationally, and this number is increasing. Until now, few studies have looked at where these kids go in an emergency, Lo and colleagues said.

Lo's research showed that most kids went to emergency departments in regular hospitals that are less prepared to handle the special needs of children.

Hoffman said, "Youth may be seeking mental health care in emergency departments due to rising rates of mental illness coupled with limited access to adequate outpatient mental health care."

The reasons for rising rates of depression and suicide among US youth are likely complex, but could include bullying, the impact of social media, or inadequate sleep, she said.

Whatever the reasons, "all emergency departments, even those that mainly treat adults, must be prepared to treat children for mental health conditions by having appropriate policies and procedures in place," added Hoffmann, who co-wrote an accompanying journal editorial.

Also, some rural areas face a shortage of mental health providers, so it may be difficult to arrange adequate follow-up care after discharge from the emergency department, she noted.

The bottom line is clear, Hoffmann said: "Sweeping changes to our nation's mental health system are needed to better prevent, diagnose, and treat mental illness among youth before conditions progress to crisis levels that require emergency care," she said.

The report was published online May 11 in the journal Pediatrics.

—Steven Reinberg

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