Emergency Department (ED) visits for children with mental health needs has been rising in recent decades, yet data suggests that less than half of EDs are prepared to treat these patients. A new study looked closer at ED characteristics and found that youth presenting with mental health disorders, particularly deliberate self-harm and substance use disorders, are not only rising, but also are often seeking care at non-children’s EDs that are less equipped to provide appropriate, higher-level pediatric evaluation and services.
The CHOP ED has over 100,000 annual visits, and with approximately 5% of these visits consisting of mental health complaints, we have a unique opportunity to understand our patient population, plan interventions, disseminate information, and advocate for additional resources. Based on our experiences in the CHOP ED, as well as suggestions from the study, there are considerations for our colleagues in non-children’s EDs, especially with lower ED volumes and those in rural settings.
- Gather a Team. In the CHOP ED, a multidisciplinary team consisting of ED physicians, nursing, advanced practice providers, social work, and psychiatry meets regularly to address the needs of patients. While many ED settings are not as resource-rich as CHOP, a team will help highlight the importance of mental health and share responsibility for understanding and meeting patient needs.
- Identify Mental Health Needs. Mental health needs can be identified for patients beyond the chief complaint through the medical evaluation and/or through universal screening. In order to understand the true scope mental health patients and resources utilized, the ED team should think about the ways they currently track patients and brainstorm additional measures. For example, include positive scores from screening tools, note if safety observation took place, utilize mental health consultation, length of stay, patient disposition, and ED re-visits for mental health concerns. These metrics can be helpful when planning for care model improvements, and advocating to hospital and ED leadership for additional resources and support, such as staffing.
- Identify Mental Health Providers. When mental health follow-up is recommended in the ED, patients risk never making the first connection to care due to barriers like a shortage of mental health providers, leading to poor patient outcomes and an increase in ED visit rates. Consider alternative options such as tele-mental health services, which we have learned can be feasible and effective during the COVID-19 pandemic, as well as partnering with institutions that have specialized pediatric mental health resources.
- Educate and Empower Staff. Many clinicians may feel uncomfortable caring for mental health patients or, due to lack of training, out of their job scope. This culture needs to change, especially as we emphasize that mental health is just as important as physical health. Immediate resources are available, including online training modules and toolkits, such as the recently published Critical Crossroads Care Pathway toolkit from Health Resources & Services Administration (HRSA).
Since most children present to non-pediatric EDs, healthcare settings and communities should invest more resources, including staff, towards mental health. Through shared experiences from frontline clinicians, ED data collection, and stories from patients and families, there is abundant evidence to make the case for all of us to do better.
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