Kids are seeking mental health help but hospitals aren't ready

Emergency departments aren't prepared for the huge increase in children seeking mental health care, according to a recent study.

The big picture: Even before the coronavirus pandemic — which is expected to exacerbate the problem — there was exponential growth from 2007 to 2016 in visits by children to hospitals for mental health emergencies, especially for those who deliberately self-harm or have a substance use disorder.

Behind the scenes: Charmaine Lo, co-author of the study in the journal Pediatrics and senior research scientist at Nationwide Children's Hospital, says the head of emergency medicine at the hospital noticed "there seemed to be a larger number of kids coming in for a mental or behavioral health disorder, and [some] providers weren't the most comfortable treating these cases."

• Nationwide Children's has a lot of resources and is very familiar with young patients, whereas other hospitals may have less familiarity and fewer resources, Lo tells Axios. That raised concern among the researchers.
• The National Pediatric Readiness Project reports less than half of EDs are prepared to treat children, Lo adds.

What they did: The team examined data from 2007 to 2016 for children ages 5 to 17 who visited emergency departments for a mental or behavioral disorder (this did not differentiate if it was the primary or secondary reason for the visit).

What they found: Overall the number of kids' visits remained stable over the decade, but those presenting with mental health disorders rose 60%.

• Visits from children with deliberate self-harm, which includes attempted suicide, cutting and ingestion, jumped by 329%.
• Visits related to substance use disorder increased by 159%, but alcohol-related disorders dropped 39%.
• They were unable to see the exact type of substances being abused, but there was a particularly high jump from 2014–2016 "that kind of falls in line with the opioid epidemic that we're facing right now," Lo says.
• However, they found a dearth in preparedness to properly handle the children who come in with these needs, partly because they were not pediatric-focused facilities or were in rural areas without training.

What they're saying: "I think we were expecting to see a rise [in mental health disorders], but I don't think we were expecting to see that much of a rise," Lo says.

• The study itself doesn't dive into the causes behind the rise, but Lo says research indicates part of the rise is due to "greater awareness" of resources that are now available.

• "While I know these findings are sad, the good news is that they're seeking help ... Now, there's less stigma," Lo says.
• But, "every emergency department needs to be prepared to take care of the kids," she adds.

Meanwhile, the COVID-19 pandemic is expected to make the situation worse for many, including children, as it has generated multiple additional stressors.

• The UN recently called for strong commitments from countries to address "decades of neglect and underinvestment in addressing people’s mental health needs [that] have been exposed by the COVID-19 pandemic."
• But, the telehealth practices that are becoming more familiar due to the coronavirus should aid in helping kids with mental health issues, Lo adds.

What's next: Lo says all EDs — rural, metropolitan, pediatric and non-pediatric — need to educate their providers with mental health-specific training and utilize current tools, like the Critical Crossroads toolkit from the Health Resources and Services Administration.

Go deeper:

• ERs often drop the ball after treating suicidal patients
• Self-harm is rising among adolescents
• Why we're failing to stop teen suicide

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 or the Crisis Text Line by texting HOME to 741741.