ERs Frequented by Kids With Behavioral Problems: Report

WEDNESDAY June 1, 2011 -- Regular outpatient care has not kept children and teenagers with mental health issues and behavioral problems from making repeat visits to the emergency room (ER), according to a new study.

Researchers from Johns Hopkins Children's Center found that more often than not, children who repeatedly end up in the ER do not actually have life-threatening emergencies.

The study, published in the June 1 issue of Psychiatric Services, examined the medical records of more than 2,900 children, ranging in age from 3 to 17 years, who were treated at the center's ER for mental health crises over the course of eight years. The analysis revealed that 12 percent of these children had a repeat trip to the ER within six months of their first visit.

The researchers also found that most of the children went to the ER seeking medical attention for behavioral problems or minor psychiatric problems, such as disruptive classroom behavior, verbal disputes and running away. Only 3 percent of the visits involved severe psychotic episodes and 10 percent were suicide attempts, the study authors noted.

Among the 338 patients who had at least two visits to the ER, about two-thirds of them reported having an outpatient mental health provider at both ER visits. Moreover, 85 percent stated during their second trip to the ER that they had a regular mental health provider. The investigators concluded that this could be a sign that patients are not receiving the care they need on an outpatient basis.

The findings are even more troubling given the fact that most ERs are not designed or staffed to provide mental health care, the study authors noted.

"We think of the ER as a 'front door to care,' but our findings suggest otherwise as a significant number of patients repeatedly seek care in the ER despite being connected to an outpatient provider," the study's lead author, Dr. Emily Frosch, a pediatric psychiatrist at Hopkins Children's, said in a news release from the center.

The researchers suggested there could be several possible explanations for the repeat ER visits, including:

  • Limited office hours may be an obstacle to effective regular outpatient care.
  • Children and their families may gravitate to ERs following prior positive experiences there.
  • Some families may see ER care as less stigmatizing than outpatient mental health services.
  • Outpatient providers may lack sufficient resources and so send patients to the ER.

Frosch and colleagues noted that more research is needed to determine the exact reasons behind these recurrent ER visits for non-emergency psychiatric problems. "We need to understand why families who are already connected to outpatient providers continue to seek ER care, why providers send patients to the ER and what role, if any, ERs may play in the continuum of care for non-psychotic, non-suicidal patients," said Frosch. "It is possible that ERs fulfill an important function in that continuum for some patients."

More information

The U.S. National Institute of Mental Health provides more information on child and adolescent mental health.

Posted: June 2011


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