COVID-19 has put the spotlight on the scarcity of mental health resources, especially for children and adolescents, but problems with access to care have been increasing for years.
A new study published this month in the journal Pediatrics found that children who attended emergency rooms in 2015 because of mental health problems were more likely to have longer waits for care than in the previous decade.
The researchers analyzed the length of stay of 36,125 patients, ages 6-17, who attended a pediatric emergency room between 2005 and 2015 using the National Hospital Ambulatory Medical Care Survey. The researchers categorized visits into waiting time increments – more than six hours, more than 12 hours, or more than 24 hours. Length of stay for mental health visits was then compared to non-mental health emergency room visits.
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Over the past decade, they found that the rate of more than six hour visits to the mental health area increased from 16% to 25% compared to unstable visits to the non-mental health area, which remained stable.
“I think the delay for children waiting in the emergency room to be released to a mental health facility or community home is a clash of our mental health systems, a boiling point,” said Katherine Nash, lead author on the study and a Fellow in the Yale School of Medicine’s National Clinicians Scholars Program. “It’s a proxy bad access indicator.”
Nash said an emergency room could be “traumatic” for a child in mental crisis because of the noise and chaos, especially in emergency rooms that are tailored for adults.
“It’s the opposite of therapeutic,” she said. “There’s also a lack of persistence with the vendors and nurses looking after you, and every hour you spend waiting there takes care of you.”
The problem is compounded by an increase in visits to the pediatric mental health emergency department, particularly during the pandemic, as well as a shortage of child psychiatrists in most hospitals in high-demand urban areas, said Hasan Memon, a child psychiatrist in private practice at Princeton. NJ, who was not involved in the study.
In the Philadelphia area, hospitals struggled to transfer children and adolescents to psychiatric wards during the pandemic due to a lack of beds. At Abington Hospital-Jefferson Health, the average waiting time for pediatric patients seeking psychiatric care through the emergency room doubled from just under 100 hours in March of last year to nearly 200 hours at the end of the year.
“There is an inadequate allocation of resources in urban areas,” said Memon. “Often there is no child psychiatrist in the emergency room. Not every psychiatric department in a hospital has a child psychiatrist. When it comes to children, there is underinvestment in mental health, so the emergency room is kind of a panacea. “
In the new study, researchers found that mental health visits had a longer rate of longer stays than non-mental health visits – 21.2% of mental health visits were longer than six hours compared to 4.8% of non-mental health visits 7.7% of mental health visits lasted longer than 12 hours, compared to 1.2% of non-mental health visits.
Often times, an adolescent patient attending the emergency room for mental health reasons will have stable vital signs so they won’t be prioritized on the triage scale, Memon said.
“It doesn’t look like anything is going to happen to them even if they have a panic attack that feels like a heart attack,” he said. “Because of this, people with mental illnesses are usually looked after last.”
The researchers also found that Latino children were almost three times more likely to experience care delays than white children. It’s not yet clear why this inequality exists, but Nash suggests that language barriers can make assessment in the emergency room a lengthy process. Placement in a facility with appropriate background services can also be more difficult due to a lack of Spanish-speaking pediatric mental health facilities, she said.
“If we had better translated assessment tools in the emergency room and a standardized form in Spanish combined with telemedicine, we could address concerns more effectively,” said Memon.
Nash said she was surprised by the results of the study, especially as the problem of longer waiting times for psychiatric care has drawn national attention from the National Association for Quality in Healthcare and researchers in recent years.
“I was hoping we’d improved over the past two decades, but the takeaway message is that it’s getting worse and worse,” she said. “We need to get more creative in how we provide mental health care in the community. Not only do we need more mental health providers, we also need people with different educational backgrounds, languages and backgrounds. It is up to us to develop a care system to address patients who do not speak English. “
Memon said tackling underinvestment in child mental health is critical to improving access. Increasing funding for school prevention programs and parenting classes could ease the burden on the current mental health system, he said.
“We know the solutions,” he said. “Basically, we just have to address them. We have to invest in the future of these children and in them. “
© 2021 The Philadelphia Inquirer
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