Youth Mental Health Crisis Reveals Care System Gaps

TOPLINE:

While overall visits to the emergency department (ED) declined between 2016 and 2021, mental health-related emergency visits for children and adolescents increased with an even greater increase in suicidality visits. The study revealed substantial missed opportunities for prevention and intervention before and after the ED encounter.

METHODOLOGY:

• Researchers conducted a retrospective observational analysis to examine the trends in pediatric mental health ED visits and primary care use in Virginia before and during the COVID-19 pandemic.
• They included individuals aged under 21 years with a mental health diagnosis from 2016 to 2021.
• The opportunity for prevention and early intervention was identified by assessing the proportion of youth who were seen in primary care or behavioral health settings 7 days, 30 days, and 1 year before the ED visit.
• Follow-up care was determined by assessing the proportion of youth who received follow-up visits for mental health or suicidality concerns in primary care or behavioral health settings within 7 days, 30 days, and 60 days after the visit to ED.

TAKEAWAY:

• Total ED visits decreased by 14.0% in 2021 compared with those in 2016, whereas visits to the ED for mental health concerns increased by 10.6% (P < .0001) and more than doubled for suicidality (P < .001).
• Among the children and adolescents visiting the ED for mental health concerns, only 6.4% were seen by a primary care physician and 10.5% were seen by a mental health provider 7 days before the visit, indicating missed opportunities for prevention.
• In the year before the visit to the ED, only 62.2% of children and adolescents were seen by a primary care physician and 37.6% were seen by a mental health provider, with similar trends for suicidality visits.
• Follow-up with primary care physicians within 60 days of visiting the ED for mental health concerns decreased, but it increased slightly for follow-up with mental health providers (P < .0001 for both).

IN PRACTICE:

“These results suggest a concerning lapse in prevention and follow-up for children and adolescents with suicidality,” the authors wrote.

“There is a critical need to train ED and primary care clinicians in pediatric mental health and suicidality, improve primary care and mental health prevention and follow-up care, build care teams, maintain multidisciplinary referral networks, and address the social and system determinants of health for where kids live, learn, and play,” they added.

SOURCE:

This study was led by Jennifer Gilbert of the Virginia Commonwealth University in Richmond, Virginia. It was published online on February 26, 2025, in BMC Primary Care.

LIMITATIONS:

This study excluded patients who paid out of pocket or received care outside healthcare systems because it utilized claims data. This analysis was focused on a single state, with the most recent data available only until 2021, and findings may not have completely represented the trends in other states. The use of the International Classification of Diseases and Current Procedural Terminology codes for diagnosis may have lacked accuracy or may not have fully reflected the presenting problems and the services received.

DISCLOSURES:

The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.