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Regular trips to mental health care providers may not prevent ED visits

Frosch E. Psychiatr Serv. 2011;doi:10.1176/appi.ps.62.6.646.

A regular outpatient mental health provider may not be enough to prevent children and adolescents with behavioral problems from repeatedly ending up in the ED, according to a study published online recently.

Analyzing more than 2,900 records of pediatric patients treated at the Johns Hopkins Children’s Center ED for mental health crises during more than 8 years, researcher Emily Frosch, MD, and colleagues found that 338 of these patients returned to the ED within 6 months of their initial visit. Most ED visits stemmed from behavioral problems or minor psychiatric crises, such as disruptive classroom behavior, verbal altercations and running away. Only a few visits involved severe psychotic episodes or suicide attempts. Two-thirds of patients reported having an outpatient mental health provider at both visits, and 288 reported at the second visit that they have a regular mental health provider.

The researchers said the findings are concerning because they may signal that patients are not actually getting the care they need on an outpatient basis.

“We need to understand why families who are already connected to outpatient providers continue to seek ED care, why providers send patients to the ED and what role, if any, EDs may play in the continuum of care for non-psychotic, non-suicidal patients,” Frosch said in a press release about the study. “It is possible that EDs fulfill an important function in that continuum for some patients.”

The researchers said one possible explanation is that patient families face barriers to routine outpatient psychiatric care, including limited office hours. Families who have had a positive experience in the ED in the past may be simply choosing to return there for subsequent problems. Also, some families may also find ED care less stigmatizing than outpatient mental health services. The researchers said future studies should explore more specifically the link between outpatient care and ED visits.

Disclosure: The researchers report no relevant financial disclosures.

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