What We Know About Youth Mental Health Visits to the ER

The Bronfenbrenner Center for Translational Research

It’s well-established that youth mental health has suffered in recent years—with wide-ranging factors contributing to the problem including the proliferation of social media among young people and the isolation created by the COVID-19 pandemic.

Last year, the U.S. Surgeon General reported that 44 percent of U.S. high-school students feel persistently sad or hopeless. In 2021, emergency room visits for suicide attempts increased by 51 percent for adolescent girls and 4 percent for boys compared to two years earlier.

Recent Study

A recent, large study sheds more light on what’s happening. Public health researchers analyzed data from 200,000 children who visited the emergency department for mental health problems at 38 U.S. pediatric hospitals from 2015 to 2020.

Their study, published in JAMA Pediatrics, found that mental health visits in the emergency department increased by approximately 8 percent annually, compared with a 1.5 percent increase for other types of visits; in addition, they found 13 percent of patients revisited the emergency department for a mental health problem within six months of their initial visit.

Interestingly, the patients most likely to revisit the emergency rooms within six months were not young people who attempted suicide or harmed themselves, but those who demonstrated disruptive, impulsive, and aggressive behaviors.

Young patients with psychotic disorders were 42 percent more likely to revisit within six months compared to patients with self-harming behaviors or suicidal thoughts. Patients with impulse control disorders were 36 percent more likely to return to the emergency department compared to self-harming patients. And patients treated with medications used as chemical restraints were 22 percent more likely to return compared with patients who did not receive those medications.

What’s going on here? There are many factors that come into play. But researchers suggest that young people with behavioral disorders are not getting the support they need from our health care system. When a young person with a behavioral health problem becomes out of control or presents a danger to others, the caregivers have nowhere to turn except the emergency department at the hospital.

National guidelines recommend avoiding chemical restraints—medications delivered via injections to subdue patients—because that can inflict trauma on the patient and lead to injuries for patients, caregivers, and family members. Despite the guidelines, a study published in 2021 found use of these medications increased by 370 percent from 2009 to 2019. The study also found these types of medications are more likely to be used on Black patients and male patients between 18 and 21 years old.

Unfortunately, there is little indication that the youth mental health crisis is improving, said Josh Felver, a licensed child and adolescent psychologist, extension associate, and visiting scholar of the Bronfenbrenner Center for Translational Research’s Residential Child Care Project.

“The youth mental health crisis is in its second decade at this point, and COVID just poured gas on the fire,” Felver said. But there are steps that health officials and educators are taking to address this serious problem, he said.

Addressing the Problem

School systems are dedicating funding to social-emotional learning initiatives to help bolster youths’ coping skills to prevent the development of mental health problems.

Adults not working as mental health professionals, such as camp counselors and teachers, are being trained to recognize red flags of serious mental health problems, and how to respond effectively to youth who are in distress so that they may be connected with mental health resources.

The federal government is allocating research funding to address the child and adolescent mental health crisis, particularly for youth with known mental health disparities including marginalized sexualgender, and racial minority groups.

And there is increasing funding for innovative solutions, such as partial hospitalization programs, to reduce the burden on emergency departments overwhelmed with pediatric behavioral and psychiatric patients in crisis.

The take-home message: Health care for young people with behavioral health problems is lacking in the United States. It’s important for public health officials, health care providers, and schools to continue to find new ways to address the youth mental health crisis.

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