COVID-19 has cast a spotlight on the shortages of mental health resources, especially for children and adolescents, but problems of accessing care have been increasing for years.
A new study, published this week in the journal Pediatrics, found children who visited emergency departments for mental health crises in 2015 were more likely to experience prolonged wait times for care than they were in the previous decade.
Researchers analyzed the length of stay for 36,215 patients ages 6 to 17 visiting a pediatric emergency department between 2005 and 2015 using the National Hospital Ambulatory Medical Care Survey. Researchers categorized visits into wait-time increments — more than six hours, more than 12 hours, or more than 24 hours. The length of stay for mental health visits were then compared with non-mental health ED visits.
In the last decade, they found that the rate of mental health visits that lasted for more than six hours increased from 16% to 25%, compared with non-mental health visits, which remained stable.
“I think that the delay for children waiting in the emergency department to be discharged to a psychiatric facility or home to the community represents our mental health system coming to a head, a boiling point,” said Katherine Nash, lead author of the study and a fellow in the National Clinicians Scholars Program at the Yale School of Medicine. “It’s a proxy indicator of poor access.”
Nash said an ED can be “traumatic” for a child going through a mental health crisis because there is a lot of noise and chaos, especially in emergency rooms tailored for adults.
“It’s the opposite of therapeutic,” she said. “There is also a lack of consistency in the providers and nurses caring for you, and every hour you spend waiting there takes away from care.”
The issue is compounded by a rise in pediatric mental health emergency department visits, especially during the pandemic, as well as a shortage in child psychiatrists in most hospitals located in high-demand urban areas, said Hasan Memon, a child psychiatrist in private practice in Princeton, N.J., who was not involved with the study.
In the Philadelphia area, hospitals have struggled to place children and adolescents into psychiatric wards during the pandemic because of a shortage of beds. At Abington Hospital-Jefferson Health, the average wait for pediatric patients seeking mental health care through the emergency department doubled from just under 100 hours last March to nearly 200 hours by the end of the year.
“In urban areas, there’s an underallocation of resources,” Memon said. “Oftentimes there’s no child psychiatrist available in the ER. Not every hospital’s mental health department has a child psychiatrist. There’s underinvestment in mental health when it comes to kids, so the ER winds up being kind of a catch-all.”