Emergency Departments See Growing Pediatric Behavioral Health Needs

Three associations recommend resources to support behavioral health safety net

August 21, 2023

The nation’s emergency departments are struggling to keep up with the number of children who need care for psychiatric emergencies.

This month, a trio of national health care associations is publishing a policy statement calling for additional support to improve access to care and provide more resources and support for patients in their communities.

The American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), and Emergency Nurses Association (ENA) released the joint policy statement, providing recommendations for the management of mental and behavior health services. They also noted disparities related to insurance, gender identity, language, the geographic location of mental health specialists and inpatient psychiatric units, and race and ethnicity.

The associations estimate about 500,000 children with mental and behavioral health conditions are evaluated in emergency departments each year, and that the number is growing.

“In many cases, an inadequate mental health infrastructure gives families nowhere else to turn but the emergency department,” said Mohsen Saidinejad, a lead author of the policy statement and member of the AAP and ACEP committees on pediatric emergency medicine “It’s a dilemma we’re experiencing more often since the COVID pandemic began.”

The organizations also recommended:

• Patient transitions:  Community engagement can support the development of emergency department transfer strategies, such as referral to psychiatric crisis units, within psychiatric facilities, or to community mental health centers.
• Mobile help:  Mental health mobile crisis teams can respond to schools, physicians’ offices, and homes.
• Addressing risk factors:  Additional resources are needed to help staff  provide care to children and youth with increased risks of mental and behavioral health concerns.
• Better assessments:  Emergency departments need complete methods to assess patients and follow protocols in triage, safety assessment, monitoring, mental health, and medical evaluation.
• Trained for care:  Pediatric-trained mental health professionals are vital to emergency department teams.
• Screening:  Increased screening can help address inequities and lead to treatment and referrals of emergency department patients for mental and behavioral health symptoms.

Terry Foster, ENA president, said a shortage of resources can create barriers to help patients with a mental or behavioral health crisis.

“This can leave individuals struggling with their mental or behavioral health in the emergency department for extended periods of time, leading to overcrowding, among other things,” Foster said. “An increase in treatment education and resources can only continue to improve the care provided for not just youth, but all mental and behavioral health patients.”

The joint policy statement and additional information about this month’s announcement are available online.