EDs are drowning under a rising number of pediatric behavioral health patients, providers warn

Amid warnings that emergency departments are not fully equipped to meet rising mental and behavioral health (MBH) needs of minors, a trio of healthcare professional organizations is calling for more support inside these facilities as well as throughout their surrounding communities.

Wednesday, the American Academy of Pediatrics, the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association published a joint policy statement highlighting the increasing role EDs have played as a critical access point and safety net for children and adolescents.

About half a million of these young patients have their MBH emergencies evaluated in these settings—a number that’s increased over the past decade and includes the uneven MBH burdens of higher-risk populations, like historically marginalized racial and ethnic groups, immigrants and refugees, LGBTQ+ youth and those of lower socioeconomic status.

“In many cases, an inadequate mental health infrastructure gives families nowhere else to turn but the emergency department,” Moshen Saidinejad, M.D., lead author of the policy statement, said in a release from the organizations. “It’s a dilemma we’re experiencing more often since the COVID pandemic began.”

However, EDs aren’t necessarily the best place for many of these children to have their needs met, Saidinejad and colleagues wrote in the policy statement.

Clinicians on staff have varying levels of experience and resources to screen and treat different types of MBH presentations, particularly if a young patient has additional needs or considerations related to their backgrounds. Additionally, patients may be held in the ED for longer than appropriate due to capacity issues at facilities offering higher levels of psychiatric care.

“Emergency physicians continue to do all they can for these vulnerable patients, while limited community and specialty resources, staffing challenges and systemic inequities accentuate systemic gaps in care,” Christopher Kang, M.D., president of the ACEP, said in a statement. “These factors add to the challenges in already crowded emergency departments with limited bed space available. Compassionate, collaborative solutions are needed to improve local and national approaches to preventing and treating mental and behavioral emergencies.”

The professional organizations’ statement came with a list of evidence-based policy and practice recommendations to improve care for these patients before, during and after a mental and behavioral health emergency.

For instance, EDs should be engaging with their communities to develop efficient transfer strategies from emergency care to inpatient psychiatric units or community-based acute treatment facilities, the groups said. EDs should also be training their staff to recognize children who potentially have higher risks of MBH concerns; explore telehealth consultations and other technologies that expand expertise or promote care coordination efficiency; and develop systematic, standardized protocols for triage, safety assessment, monitoring and evaluation.

More broadly, communities could fill in the gaps with school-based screening and community-based services that adopt a “culturally sensitive, patient-centered approach” that helps spot MBH concerns before they escalate into an emergency, the groups wrote. Stakeholders on both sides should also advocate for additional resources to research and address the increased MBH burden on children, support increased funding for pediatric mental health specialists and expanded insurance coverage, among numerous other measures.

“A dedicated multipronged, multidisciplinary approach will be necessary to provide patient-centered, trauma-informed services to improve the care of children and youth with MBH emergencies,” the groups wrote.