On any given day, Children’s Mercy Kansas City will see about 24 children in the emergency room with behavioral or mental health issues.
The most common mental health disorders that children are diagnosed within the ER are mood disorders, anxiety disorders and behavioral and emotional disorders.
Emily Snow, senior Administrative Director for behavioral health at Children's Mercy Hospital, said they’ve seen these types of visits increase as much as 20% annually in recent years.
“We have kids as young as 3 who are coming through the emergency room,” Snow said. “We also have a lot of kiddos who come through who have neurodevelopmental disorders or autism spectrum disorders who are struggling either with behavioral dysregulation or medication adjustment needs. It's very hard to get care right now.”
In ERs across the city, the same situation is playing out — but with hospitals even less equipped to handle the load.
Emergency rooms aren’t guaranteed to have sufficient space or staff trained to manage pediatric mental health cases, which can mean long wait times or insufficient care for the patients.
According to a study published earlier this month by the CDC, over 1 million emergency room visits each year are attributed to children and adolescents with a mental health disorder diagnosis. And the number of pediatric ER visits for mental health reasons has increased year-over-year — up 8% each year from 2015 to 2020 — significantly outpacing other types of visits.
Snow noted a workforce shortage of mental health professionals for children hitting Kansas City and the rest of the country. The CDC study echoed this concern, noting emergency departments are now the first response for immediate mental health needs, as the number of psychiatric facilities dwindles and outpatient services become harder to access.
According to Children’s Mercy, only 30-50% of the 15 million children in need of mental health treatment receive that care.
In Kansas City, about 40-50% of kids go untreated. Earlier this year, Children’s Mercy CEO Paul Kempinski estimated there are only about 166 inpatient psychiatric beds for children in the entire region.
“We're going to have to look at this in a unique way and look at all angles of workforce development to be able to help these children,” Snow said.
For those arriving in the ER for mental health, the CDC reported mood disorders were diagnosed in 5 visits per every 1,000 children and adolescents. The rate was 4.4 for anxiety disorders, 3.7 for behavioral and emotional disorders, 1.8 for substance use disorders and 1.7 for developmental disorders.
The CDC also found girls make up more mental health ER visits than boys. Visit rates were 16.1 for girls per 1,000 children and adolescents, compared to 12.1 for boys.
This burgeoning crisis is part of the reason that, earlier this year, Children’s Mercy announced earlier the start of the Illuminate project, a $150 million investment into 14 efforts around behavioral health. One project is to create an acute mental health crisis center, a separate unit within the emergency department staffed with social workers, behavioral health technicians and psychiatrists.
Snow estimated this unit will be up and running in 2025. In the meantime, the newly-created Depression and Anxiety in Youth (DAY) Clinic will help bridge the gap for patients ages 12 to 17.
During the 12-month program, patients will have access to experts in psychology, social work and nursing who will work together to provide group and individual therapy, as well as medication management. After the year is up, patients can transition to community resources for further support.
The University of Kansas Health System’s Marillac Campus in Overland Park also offers a continuum of specialized behavioral healthcare services for children and adolescents. Services include an acute psychiatric hospital, a partial hospital program and outpatient care.
Lauren Lucht, vice president of mental and behavioral health for the KU Health System, said the Marillac Campus can help get people in for treatment without going to the emergency department, but that alone isn’t enough.
She said there needs to be broader community support and pressure on legislative leaders to improve parity and benefits for those struggling with mental health concerns.
“We want to urge our insurance companies and our legislators to decrease or get rid of the parity between our mental health benefits that are covered by our insurance plan compared to our medical benefits,” Lucht said. “A great example of that parity, and this would be in on your medical plan for your insurance, would be you get an annual preventative care wellness visit each year.”
Earlier this year, the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association penned a joint policy statement warning emergency rooms cannot sustain this surge in visits without local support.
“A dedicated multipronged, multidisciplinary approach will be necessary to provide patient-centered, trauma-informed services to improve the care of children and youth with (mental and behavioral health) emergencies,” wrote lead author Mohsen Saidinejad.
The groups also provided some recommendations that could reduce reliance on mental health crisis teams. These include using local mental health crisis teams as an alternative to law enforcement, creating a referral network among hospitals and outpatient treatment centers and developing national standards for youth mental health consultations.
They also suggested increased funding for training, particularly training a diverse population of pediatric mental health providers to reflect the community they serve.
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