Dubai, United Arab Emirates (CNN) — Every night that Dr. Jennifer Hoffman works as a pediatrics assistant, she says, at least one child comes in with a mental health or behavioral emergency.
During her career, she has noticed that the number of young people who need help is growing exponentially.
“The most common problems I see are children who have suicidal thoughts or children who have severe behavioral problems and are therefore at risk of harming themselves or others,” said Hoffman, who works at Ann & Robert H. Lurie Children’s Hospital in Chicago.
She continued, “We are also seeing younger children, especially since the beginning of the pandemic. Children as young as 8, 9 or 10 years old are coming to the emergency department with mental health concerns.
“It’s amazing.”
Studies have shown that increasing the number of children attending emergency departments with mental health problems was a challenge even before 2020, but rates have increased during the COVID-19 pandemic.
Emergency staff may be able to stabilize a child in a mental health care crisis, but research has shown that timely follow-up with the caregiver is key to their long-term success. Unfortunately, it seems there aren’t enough of it, according to a new study co-authored by Hoffman. Without proper follow-up, these children often end up back in the emergency room.
For the study, published Monday in Pediatrics, Hoffman and co-authors looked at the records of more than 28,000 children, ages 6 to 17, who were enrolled in Medicaid and had at least one emergency department visit between January 2018 and June 2018. June 2019. They found that less than a third of children benefited from an outpatient mental health visit within seven days of being discharged from the emergency room. Just over 55% had follow-up at 30 days.
Research has shown that following up with a mental health provider reduces a person’s risk of suicide, increases their chances of taking prescribed medications, and reduces their chances of making frequent trips to the emergency room.
The new study also found that without follow-up, more than a quarter of the children had to return to the emergency room for additional mental health care within six months of their initial visit.
“The emergency department is like a safety net,” Hoffman said. “It’s always open, but there’s a limited range of types of mental health services we can provide here.” “This speaks to the reality of insufficient access to the services these children need,” she added. She added that this dynamic can be “disruptive” for parents and emergency department staff alike.
The lack of professional help is a problem for many children. Before the COVID-19 pandemic, the US Centers for Disease Control and Control found that 1 in 5 children had a mental health disorder, but only about 20% received care from a mental health provider.
Children’s mental health is such a concern in the United States that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national emergency in 2021.
And Hoffman’s study found that black children perform worse than their peers. They were 10% less likely than white children to receive timely follow-up, “which is very concerning, given that there are so many disparities in access to care within our mental health system.”
The study was unable to determine why this racial disparity exists, but Hoffman believes there may be some factors at play.
Black children are more likely to live in neighborhoods with a shortage of mental health workers. There is also limited diversity among the mental health workforce.
Studies indicate that about 84% of psychologists are white, as well as approximately 65% of counselors, and more than 60% of social workers. Studies show that black children more often depend on school mental health services.
Although the number of school counselors has increased over the years, few schools meet the National Association of School Psychologists’ recommended ratio of one school psychologist for every 500 students.
The new study found that children who didn’t get mental health help before their emergency visits had more difficulty receiving timely care afterward.
Dr. Tony Gross, chief of emergency department at Children’s Hospital of New Orleans, who was not involved in the study, said she wasn’t surprised by the study’s findings, and “I’m well aware of the fact that we need more providers of these services.”
She considered that the lack of service providers who could conduct follow-up was a real concern.
Like many children’s hospitals, it has an active partnership with local school health programs that can provide some mental health care.
Hoffman said the amount of support varies by emergency department.
Hoffman hopes her study will spur policymakers to invest more so children can get care no matter where they live.
An accompanying commentary written by the authors noted, “This new analysis adds to the overwhelming evidence that there is an urgent need for fundamental change in our child mental health care system.”
