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Among Young People, Emergency Room Visits For Mental Health Have Doubled In The Last Decade. ERs Can't Keep Up

A person walks in a crosswalk in front of a large gray building displaying the words Cedars-Sinai Medical Center.
A pedestrain crosses a street at Cedars-Sinai Medical Center in Los Angeles on Sept. 7, 2012.
(Frederic J. Brown
AFP via Getty Images)
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In the last decade, mental health-related emergency room visits by young people ages 6-24 have approximately doubled — accounting for 13 percent of ER visits overall.

This is according to a new study from the Journal of the American Medical Association, which looked at data from the National Hospital Ambulatory Medical Care Survey. Substance abuse issues like opioid usage is increasing, while visits related to suicide ideation and attempts increased by five times.

Dr. Tanner Bommersbach, assistant professor of psychiatry at Mayo Clinic and one of the authors of the study, joined LAist 89.3’s public affairs show AirTalk to discuss how emergency rooms are handling this rise, and what might be underlying this time of crisis.

A shortage of mental health clinicians at ERs

Though pediatric emergency room visits overall have remained stable in the last 10 years, a larger share of those visits are now for mental health situations, according to Dr. Bommersbach. Outpatient services in the community are overwhelmed and often under-resourced, he says, leading many youth to arrive at the ER seeking routine mental health care.

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“We were really interested in understanding emergency room visits as a proxy measure for unmet mental health needs among children in the community,” Dr. Bommersbach says.

But sometimes, those needs might remain unmet even at the ER. One caller said she felt that her adult children did not find a compassionate environment at the ER, and were discouraged from seeking further psychiatric support — a story Dr. Bommersbach says it heartbreaking and common.

Part of this could be because, as his study found, fewer than 10 percent of these youth who arrive at the ER are seen by a mental health clinician, such as a psychiatrist. Often they’re instead seeing an emergency room physician — who, despite being well-trained to triage and offer support, do not have the same level of expertise in this area as a mental health clinician.

Variable needs of ER patients

Dr. Sam Torbati, co-chair and medical director of the department of emergency medicine at Cedars-Sinai Medical Center, says they're able to provide each patient with a mental health specialist, but many ERs are not structured and resourced enough to provide personalized care for psychiatric patients. So many patients do not find the ER to be the supportive environment they might have sought.

“For the average ER that's being asked to deal with gunshots and stroke and heart attacks and sore throats and psychiatric emergencies all at the same time, the variable needs for all those different patient populations can be quite challenging,” Dr. Torbati says. “And it can unfortunately lead to a very poor experience.”

Dr. Bommersbach says even some who are not in acute crisis might arrive at the ER for resources they could not find at outpatient programs. He says the crisis system, like crisis centers and mobile teams, needs to be expanded so patients don’t always have to go to the ER, and can find services more specific to their needs.

“We really need a dedicated national commitment to not only improve our care in emergency departments and hospitals for these patients, but also to expand non-hospital alternatives for care for young people,” Dr. Bommersbach says.

Los Angeles has some of these systems in place, but there are not enough beds available to provide each patient with support for their ongoing needs throughout their crisis. Dr. Torbati says the ideal model would entail specialty sites that the ER can refer patients to for extensive care based on their specific situation, after the immediate medical needs are taken care of.

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“If we're not the best people to do it, we want to get you into those hands,” Dr. Torbati says. “And that's the model of care for everything. If a patient comes to one ER and they need heart surgery and that center can't do it, we'll send them to the center that can.”

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