ED visits for mental health have increased significantly in past decade
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Mental health-related emergency department utilization significantly increased in the past decade, according to study results published in Journal of Clinical Psychiatry.
“Most studies of mental health ED use are by now outdated as they used data from years prior to the full implementation of the [Affordable Care Act],” Kayla M. Theriault, MPH, of the department of public health sciences at University of Connecticut School of Medicine, and colleagues wrote. “Although one recent study reported a 28% increase in pediatric ED visits for mental health conditions from 2011 to 2015, these findings cannot be generalized to the larger adult population. Another study similarly found that mental health-related ED visits increased by 16.5% between 2006 and 2011, but these data are now almost a decade out of date, and this study was unable to examine the most recent post-ACA trends or provide data on ED use by type of mental health conditions.”
In the current study, the investigators used a repeated cross-sectional analysis of a nationally representative sample of ED visits in the U.S. from the National Ambulatory Medical Care Survey. Specifically, they sought to examine correlates and trends of mental health-related ED visits from 2007 to 2016 and paid attention to changes in ED use after 2014, which is by when the ACA had been fully implemented. Further, they used diagnoses linked to each ED visit to identify changes in proportions in mental health diagnostic categories, including substance use-related diagnoses only, psychiatric diagnoses only or both, based on ICD-9-CM or ICD-10-CM criteria. They also examined trends by insurance status, age, sex and race/ethnicity. Using multivariate logistic regression analyses, they evaluated the statistical significance of temporal patterns.
Results showed approximately 8.4 million (8.3%) of 100.9 million ED visits in the U.S. during this time period were for psychiatric or substance use-related diagnoses. The proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9% (P < .001) over the decade. Moreover, visits related to alcohol and “other” substance use and psychiatric diagnoses termed “other” comprised an increasing portion of ED visits for mental health during this period (P < .001). Medicaid was the primary insurance coverage source in the portion of visits with the largest increase, from 27.2% between 2007 and 2008 to 42.8% between 2015 and 2016 (adjusted odds ratio for linear trends = 1.71; 95% CI, 1.36-2.15).
“One explanation for this increase is because substance-related problems, which include overdose/self-injury issues, have increased over time,” Taeho Greg Rhee, PhD, MSW, of the department of public health sciences at University of Connecticut School of Medicine, told Healio Psychiatry. “It makes sense, as recent increases in opioid, cannabis and amphetamine use have all increased across the country. Another explanation is that although mental health care access has been expanded through [the ACA], people (especially those with lower socio-economic backgrounds) do not know how to get access to care and still remain underserved."
Rhee noted that if mental health-related ED visits continue to increase in the future, several steps can be taken.
“ED providers need to be better equipped with mental health care,” Rhee added. “Behavioral health should be better integrated as part of the care coordination. Reimbursement models across different insurance types (i.e., Medicare, Medicaid and private) should consider expanding their coverage of mental health treatment in ED settings.”