Adolescents Mental Health-Related ED Visits Notably Increased in 2021

The second year of the COVID-19 pandemic witnessed significant changes in the utilization of acute mental health care services among youth aged 5 to 17 years. The findings of this cross-sectional study demonstrated a rise in mental health emergency department (ED) visits, psychiatric admissions, length of inpatient psychiatric stay, and prolonged boarding.¹

The effect of the COVID-19 pandemic has impacted various aspects of society, including mental health. Understanding how the utilization of acute mental health care services has changed among youth during the pandemic is crucial for effectively directing resources and providing appropriate support.

Lindsay Overhage, MD-PhD candidate, Department of Health Care Policy, Harvard Medical School, and a team of investigators, conducted a recent cross-sectional study that analyzed data to investigate the changes in mental health care utilization among youth aged 5 to 17 years during the second year of the pandemic.

The study utilized national, deidentified commercial health insurance claims of youth mental health ED and hospital care between March 2019 and February 2022. The investigators compared the data from the baseline year (March 2019-February 2020) with the second year of the pandemic (March 2021-February 2022).

Included in the analysis were 4.1 million commercial insurance enrollees, with 17,614 youth having at least 1 mental health ED visit in the baseline year and 16,815 in year 2. Results revealed several concerning trends in the utilization of acute mental health care among youth during the second year of the COVID-19 pandemic.

Key Findings

• Increase in Youth with Mental Health ED Visits: There was a 6.7% increase in the fraction of youth with any mental health ED visits compared to the baseline year. Among adolescent females, the increase was even more significant, with a 22.1% rise.
• Higher Rate of Psychiatric Admissions: The percentage of mental health ED visits resulting in inpatient psychiatric admission increased by 8.4%. This indicates greater severity of mental health conditions requiring more intensive care and treatment.
• Extended Length of Inpatient Psychiatric Stay: The mean length of inpatient psychiatric stay following an ED visit increased by 3.8%. This suggests that youth requiring inpatient psychiatric care may need longer treatment and support during the pandemic.
• Prolonged Boarding in ED: The study found a substantial 76.4% increase in the frequency of prolonged boarding, defined as a wait of two or more midnights, in the ED or a medical unit before admission to an inpatient psychiatric unit. This indicates a strain on the acute mental health care system and delays in receiving appropriate care.

According to the research, this underscores the urgent need for interventions to address the increasing demand for acute mental health care among youth during the COVID-19 pandemic. The investigators specifically emphasized multiple recommendations:

• Increase Inpatient Child Psychiatry Capacity: The rise in mental health ED visits and psychiatric admissions suggests a need for expanding inpatient child psychiatry services to accommodate the growing demand for specialized care.
• Reduce Strain on Emergency Departments: Efforts should be made to alleviate the strain on emergency departments by implementing strategies such as improving access to community-based mental health services, enhancing crisis intervention programs, and developing appropriate triage protocols.

To address these concerning trends, interventions focused on expanding inpatient child psychiatry capacity and reducing strain on the acute mental health care system are imperative, the team wrote.

References:

1. Overhage L, Hailu R, Busch AB, Mehrotra A, Michelson KA, Huskamp HA. Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic. JAMA Psychiatry. Published online July 12, 2023. doi:10.1001/jamapsychiatry.2023.2195