ERs Filling Up with Psych Cases.
Millions more visits were linked to the conditions in 2015 compared with 2009.
A new report suggests that the burden of mental illness in the emergency room spiked during the first half of this decade. Researchers who examined the period of 2009-2015 found a 41% jump in visits to American emergency departments (EDs) by adult patients believed to have mental health disorders. The annual number of these visits grew to 10 million from seven million.
In 2015, an estimated 3.4% of pediatric patients and 9.9% of adult patients were discharged with mental health diagnoses, according to the researchers. That’s up from 2.1% and 6.9%, respectively, in 2009.
The findings are “shocking” but not surprising, said the study’s lead author, Genevieve Santillanes, MD, of the University of Southern California’s Keck School of Medicine, speaking at the annual scientific meeting of the American College of Emergency Physicians.
“In 2015, more than one in 10 ED visits by 15- to 64-year-olds were mental-health related,” she said in an interview. “Despite that, most EDs do not have the resources necessary to provide optimal care for patients with mental health conditions.”
As Santillanes noted, the impact of the mental health crisis on the ED has gotten significant attention from emergency medicine providers and the media. “Despite this,” she said, “recent, nationally representative data is limited.”
Santillanes and colleagues examined National Hospital Ambulatory Medical Care Survey data from 2009 to 2015. The survey makes estimates about visits to general, non-federal, short-term hospitals.
The researchers focused on cases in which mental health disorders — including substance abuse disorders — were listed among the top three diagnoses in discharge data.
According to the study, annual mental health visits for children grew from 700,000 to 1.1 million, an increase of 56%, while adult visits grew by 41%.
Meanwhile, the percentage of mental health-related visits that led to inpatient care for all groups dropped from 30% to 20% (P=0.004), while length of stay for inpatients grew from 401 to 528 minutes, a 31% increase (P=0.006).
“Most EDs do not have the resources to provide treatment to patients with psychiatric emergencies, so patients spend many hours boarding in the ED without receiving meaningful treatment,” Santillanes said. “We wouldn’t accept this for patients with other medical or surgical emergencies. Besides the negative consequences for patients awaiting psychiatric admissions, these prolonged lengths of stay contribute to ED crowding.”
Why do more patients with mental health problems seem to be coming into the ER? “I suspect this is multifactorial,” Santillanes said. These numbers and the nation’s increase in suicide rates “would suggest there is an unmet need for earlier treatment of mental health disorders.”
In pediatric patients, she added, awareness may be a factor: “Educators, school counselors, social workers, and other professionals who work with children and adolescents are aware of the increase in suicide rates. Recent multiple mass shootings in schools may be driving visits as well. Educators cannot take the risk of missing warning signs in students who may harm themselves or others. Most schools have limited mental health resources, and their only option to ensure urgent evaluation of students is to send them to an ED.”