Our emergency rooms are telling us something alarming about children’s mental health. We should listen. A new statewide survey of Illinois emergency departments, led by Dr. Jennifer Hoffman of Ann & Robert H. Lurie Children’s Hospital, offers one of the clearest pictures yet of what happens (and what doesn’t happen) when a child arrives at an emergency department with a purported behavioral health crisis.
Emergency care coordinators across the state do their work with dedication and skill. But many survey respondents admittedly practice at hospitals with no dedicated pediatric inpatient unit, and only about half of those have a mental health professional on site. As summarized in the report, only 56% of such providers consistently deliver every recommended element of safety planning before a child goes home. Only 25% routinely schedule a follow-up mental health appointment before discharge. Even the most skilled emergency personnel are limited by their available resources.
Answers aren’t beyond reach or reason. The study highlights how many care teams have little-to-no sensible referrals or placements available, and that emergency staff are ill-equipped to meet certain needs that extend well beyond an immediate crisis. The result is prolonged boarding. Children wait in emergency departments, sometimes longer than three days, because there is nowhere else for them to go. We would not tolerate this for a child with an urgent physical injury. Why do we expect children with mental health conditions to simply endure?
An emergency room should be one door among many, not the only door. That means investing in the continuum around the hospital: mobile crisis teams, which research links to fewer repeat emergency department visits among youth; real-time visibility into psychiatric bed availability for quicker placements when appropriate; peer and family support that begins before a crisis and continues after discharge; and community settings where a young person can stabilize with dignity. It also means better support inside the ER while children wait and wait.
This is fixable. Coordination matters. So does dedicating real resources to it. Families, policymakers, health plans, hospitals, schools and community organizations all share responsibility for building a system where fewer children reach the ER in crisis. Above all, the study underscores that we can all do better for our children’s mental health.
– Matt Davison, CEO, NAMI Chicago