ERs Frequented by Kids With Behavioral Problems:
WEDNESDAY, June 1 (HealthDay News) -- 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
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
- 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
The U.S. National Institute of Mental Health provides more
child and adolescent mental health.
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