Childrens' Suicide Emergency-Room Visits Spiking
Half occurred in hospitals with lower pediatric volume that often lack specialized resources to care for kids in mental health crises.
Emergency visits by children with suicide-related crises increased by 74%, according to a study representing over 5 million emergency department (ED) visits for mental health concerns by U.S. children from 2016 to 2022.
About half of suicide-related ED visits – and half of all children’s mental health ED visits – occurred in hospitals with lower pediatric volume (under 10,000 annually). These EDs often are not prepared to care for children with acute mental health needs. The study was published in Annals of Emergency Medicine.
“A child experiencing a mental health crisis may arrive at any emergency department. Our findings underscore the need to equip every ED – not only large pediatric centers – with tools and resources to provide evidence-based mental health care,” said lead author Audrey Brewer, MD, MPH, a pediatrician and researcher at Ann & Robert H. Lurie Children’s Hospital of Chicago, and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Strengthening mental and behavioral health capacity across all emergency care settings is essential to ensuring children receive timely, effective and equitable care.”
She stressed that all EDs need additional training and access to pediatric mental health professionals, either onsite or via telehealth, as well as linkage to follow-up care. Every ED also needs to offer universal suicide screening for children, and if there are concerns, families should be provided with a clear plan to help keep their child safe at home.
Dr. Brewer and colleagues analyzed ED visits among children aged 5-17 years with a primary mental health diagnosis, using the Nationwide Emergency Department Sample database.
Highlights of the findings:
Pediatric mental health-related ED visits increased by 24% during the study period.
The most frequent mental health diagnosis groups were suicide or self-injury (24%) and depressive disorders (23%).
Indigenous children were more likely to come to EDs with lower pediatric volume.
Youth with substance use concerns were seen more often at lower pediatric volume EDs.
At EDs with the lowest pediatric volume, close to 30% of children seen for mental health conditions were transferred to other hospitals to receive definitive care.
“Transfer to another hospital for pediatric mental health care often means a prolonged wait in the ED, sometimes lasting days, increasing the burden on children and their families,” said senior author Jennifer Hoffmann, MD, MS, pediatric emergency medicine physician and researcher at Lurie Children’s and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Toolkits are readily available to help EDs care for children with mental health needs, especially while kids wait for a transfer to another facility.”
Dr. Hoffmann referred to the New England Regional Behavioral Health Toolkit, as well as the National Pediatric Readiness Project that EDs across the country can join to improve the care they provide children, including youth with mental and behavioral health conditions.
“To improve care, ED-based mental health interventions need to be developed and tested for children of color, since many have not been studied in diverse populations,” added Dr. Brewer. “Delivering culturally responsive evidence-based interventions for children in the community and outpatient primary care settings can help to potentially lessen ED reliance for mental health care and may help reduce disparities in youth mental health outcomes.”