Child Mental Health ED Visits Rise in Second Year of Pandemic

According to a study led by researchers from the Department of Health Care Policy at Harvard Medical School, the number of young people visiting hospital emergency departments in the United States for mental health crises increased dramatically during the second year of the COVID-19 pandemic. The findings were published in JAMA Psychiatry on July 12.

These findings come amid growing national concern about a crisis in juvenile mental health, and they reveal critical new information about how young people with mental health issues, such as self-harm and suicidal ideation, use acute medical services.

According to the researchers, the findings emphasize the important need for policies to increase mental health resources for all parts of care, including emergency departments, inpatient pediatric mental health facilities, primary care, and preventive.

“The bottom line is that as a society, we need to do more to protect the psychological health and well-being of our young people,” said Haiden Huskamp, Henry J. Kaiser Professor of Health Care Policy at HMS.

Youth mental health epidemic persists

Numerous publications have emphasized that the COVID-19 pandemic’s stress and isolation have aggravated what U.S. Surgeon General Vivek Murthy has termed as an adolescent psychological health crisis.

And, as multiple studies have revealed, this is not a new tendency. When compared to the previous decade, the suicide rate among young people soared by 57% in the decade preceding the pandemic. The psychological health care system has been challenged for a long time, according to the researchers, due to a growing frequency of psychological disease among youngsters and a chronic scarcity of clinicians.

According to the writers, the epidemic aided in bringing those lingering issues to a head. COVID-19’s many and compounding pressures have taken a heavy toll on the mental health of a generation of young people, they claim, and are stressing an already overburdened mental health care system.

“One of the most concerning findings was the dramatic increase in the number of adolescents waiting multiple days in the emergency room before being admitted to facilities that can provide the level of treatment they need,” said Huskamp.

Concerning Emergencies in Mental Health Care

The researchers looked at private health insurance claims received between March 2019 and February 2022 for more than 4 million persons aged 5 to 17. The researchers compared the number and outcomes of emergency department visits for mental health disorders in the year preceding the COVID-19 pandemic (March 2019 to February 2020) with data from the pandemic’s second year (March 2021 to February 2022).

The young individuals in the study sample were 7% more likely to have visited an emergency room for psychological health in the second year of the pandemic than they were in the previous year. The overall increase was driven by a substantial increase in emergency department visits among adolescent females, who were 22% more likely to have visited an emergency room during the pandemic’s second year compared to the year before the virus struck.

“One surprising and concerning finding was that the increase in ED visits was largely driven by girls who came to the hospital for conditions such as suicidal thoughts or plans, suicide attempts, and self-harm,” first author Lindsay Overhage, an HMS MD/PhD student with an interest in mental health policy, said. “It’s critical that we do all we can to prevent these serious illnesses and to treat those who are suffering.”

Overall, the risk of a child being admitted to an inpatient psychological health program after visiting the ED for mental health care increased by 8% in the second year of the pandemic, compared to the year before the outbreak. The number of young people who waited at least two days after leaving the ED to be admitted to an inpatient psychiatric service increased by 76%.

How to Care for Children in Need of Mental Health Services

According to the researchers, the findings highlight the urgent need to identify and alleviate the underlying pressures causing this fast rise in depression, anxiety, self-harm, and other major mental health problems among young people in order to prevent suffering. They emphasized that these initiatives must include research to assist understand why girls have suffered more than boys.

The study also emphasizes the significance of working quickly to increase inpatient and outpatient child psychiatry capacity in order to provide young people in crisis with the care they require while reducing the load on the acute mental health care system, according to the researchers. The researchers propose a number of solutions to this problem, including increased inpatient capacity, increased availability of mental health providers, prevention and treatment of burnout among mental health care providers, and support for nonspecialist primary care and emergency care clinicians who provide psychological health care.

The researchers add that for children in crisis right now, there are promising treatments that can be provided in emergency departments, in person, or via telemedicine. These therapies may lessen the need for hospitalizations or, at the very least, allow patients to begin therapy while waiting for a slot in an inpatient program.

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