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Emergency room doctors and pediatricians are pleading for help with a flood of children and teenagers showing up at emergency rooms due to mental health issues.
A surge of mental health emergencies among children has overwhelmed emergency rooms, according to a joint paper released Wednesday by the American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA).
The children showing up in crisis are often suffering from emergencies related to anxiety, depression, and suicidal thoughts or attempts, the groups said.
“The ER has become a de facto referral center for all of these problems, and there’s too many of them for the emergency department to manage,” said lead author Dr. Mohsen Saidinejad, who directs pediatric emergency medicine at the Ronald Reagan UCLA Medical Center. Saidinejad is also a member of the AAP and ACEP committees on pediatric emergency medicine.
“That is not who we are as ER physicians. We are not mental health professionals. We cannot provide definitive care,” Saidinejad said.
About half a million children with mental or behavioral health problems show up at emergency rooms each year, according to the joint paper. That number was already rising before the pandemic, but the pandemic exacerbated the crisis, the physician groups said.
One issue emergency rooms encounter is that pediatric mental health crises tend to be very complex and require much longer hospital stays. The average pediatric mental health stay is 17 hours compared to an average five hours for all emergency room stays, according to the paper.
The pediatric mental emergency visits also drain “resources that would have been needed to run the normal medical operations of the ER, so that increases of length of stay for the other patients as well,” Saidinejad said.
Another issue is that children who arrive at emergency rooms in crisis are less likely to get the follow-up care they need if they only go to an emergency room rather than a psychiatric crisis center or community mental health center, according to Saidinejad.
The physician groups are calling for several measures to address the crisis.
One measure is community-based teams that could respond to children in crisis at school, in doctors’ offices, and even at their homes. Another measure is placing pediatric mental health professionals in emergency departments. Another aid the groups suggested is supporting emergency department staff with information about high-risk children, such as abuse victims and post-traumatic stress disorder.
The country’s mental health system needs to be expanded as well, the paper’s authors said.
There is only one mental health professional for every 124,000 children, and as many as 55% of all counties do not have even one psychiatric professional, Saidinejad said.
Telehealth for children’s mental health could also help in treating children before they land in the emergency room, the authors said.
“We in the ER are basically a safety net. We can’t say no to anything. We have to accept whatever comes our way. And I think that is why everybody is referring these children to the ER,” Saidinejad said.