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About Mental Health

The number of children and young adults visiting the emergency department for psychiatric concerns rose 28 percent over a four-year period, and visits having to do with suicide more than doubled, according to a study published this week in the journal Pediatrics.

The findings amplify concerns that the mental health care system is failing to meet the country’s needs, forcing people to rely on emergency rooms ill-equipped to deal with psychiatric concerns.

“If it’s a true crisis, the emergency department is really one of the only places we have,” said Luther Kalb, a co-author of the study and assistant professor at the Kennedy Krieger Institute in Baltimore. “But it’s not the best place to get routine care.”

Researchers examined national data on emergency room visits between 2011 and 2015.

They found the growth in visits was largely driven by adolescents and youth of color, but they’re not sure why. It could reflect a greater prevalence of mental illness, or it could be the result of greater awareness leading people to seek help, Kalb said.

Researchers also found only 16 percent of patients in the emergency room for psychiatric concerns saw a mental health specialist. When the visits were for suicide or self-harm specifically, that number went up to just 37 percent.

“Even in a crisis, you’re not going to get the most qualified care there,” Kalb said.

Many ERs don’t have a psychologist or psychiatrist on staff, and there’s an overall shortage of mental health providers in the country.

But as rates of suicide increase across the nation, and about one in 10 youth struggle with a serious psychiatric disorder, experts are increasingly turning to emergency rooms as an opportunity to identify people at risk and get them help before they get worse.

A recent federally funded study found nearly a third of children ages 10 to 12 who were asked about suicidal thoughts in the emergency room were identified as at-risk — including 7 percent of those who had gone to the emergency room for physical complaints only.

The study authors said their results show how important it is to screen kids as young as 10 for suicide risk.

But in many emergency rooms, this type of screening doesn’t happen, meaning youth with psychiatric concerns can go home without mental health care.

It also means the increase in psychiatric visits seen in recent years is an undercount. “When you actively screen for mental health problems in the (emergency department), you’re going to get a much higher number,” Kalb said.

By the time individuals visit the emergencry room for mental health concerns, they’re often in crisis, Kalb said.


Published Aneri Pattani is a Philadelphia Inquirer writer.