It’s a frustrating and familiar sight for emergency room doctors: children brought in by frightened or overwhelmed caregivers, returning again and again in the grip of mental health crises.
While rates of depression and suicidal behavior among adolescents have skyrocketed in recent years, much has been written about the rise in pediatric mental health emergency visits. Patients often spend days or weeks in examination rooms waiting for a rare psychiatric bed to open, which sharply reduces hospital capacity.
But a large study published Tuesday found a surprising trend among adolescents who repeatedly visit the hospital. Patients most likely to return to the ER were not patients who self-harmed, but those whose agitation and aggressive behavior were too much for their caregivers to manage.
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In many cases, repeat visitors have previously taken sedatives or other medications to rein in their behavior when their behavior became irritating.
A pediatric emergency room physician at Children’s Hospital of Los Angeles, Dr. authors of the study. “Your child’s behavior may pose a danger to themselves as well as to their parents and other children in the household.”
The findings, published in the journal JAMA Pediatrics, analyzed more than 308,000 mental health visits at 38 hospitals between 2015 and 2020.
Compared with patients who were suicidal or self-harming, those with psychotic disorders were 42% more likely to return to the emergency room within six months, according to the study; Patients with impulse control disorders were 36% more likely; and patients with conditions such as autism and ADHD were 22% more likely. Patients who needed drugs to soothe them were 22% more likely to revisit than patients who didn’t.
Cushing said the results show that researchers need to focus more on families whose children have cognitive and behavioral problems and may return to emergency services.
“I’m not sure we’re spending too much time talking about these agitated and behaviorally disorganized patients, at least on a national scale,” he said.
The frequency of return visits indicates that the care they receive in the emergency rooms is “really inadequate”.
Ashley A said the guidelines recommend using so-called chemical restraints — benzodiazepines or antipsychotics administered by injection or intravenous drip — as a last resort because they can traumatize or cause physical injury to the patient, medical personnel or caregivers, Dr. Foster is an assistant professor of emergency medicine at the University of California San Francisco.
The use of these drugs in pediatric emergency services has increased in recent years. According to a study by Foster and colleagues published last year, chemical restraint use increased by 370% between 2009 and 2019, while mental health emergency room visits increased by 268%.
According to the study, the drugs were mostly used in Black patients and male patients between the ages of 18 and 21. Foster described these disparities as “worrying and motivating to think about how to improve fair care.”
A child and adolescent psychiatrist at Boston Medical Center, Dr. Christine M. Crawford said caregivers of children with conduct disorder often seek emergency care when they “get to a point where someone could get hurt.”
“They’re entering the sixth, seventh, eighth grades—that’s when we see families struggling for a long time,” said Crawford, who is also an assistant professor at Boston University School of Medicine.
He said families in this situation are “highly isolated” and often hide their struggles from friends and relatives. Emergency room treatment is comforting for caregivers, but provides little long-term benefit, she said.
“It’s just putting a Band-Aid on the problem,” he said. “They go home and are still waiting for that appointment to see a therapist.”
A psychiatrist and researcher at Lurie Children’s Hospital in Chicago, Dr. Andrea E. Spencer said that while behavioral disorders may be less urgent to dismiss than suicidal thoughts or self-harm, they are actually “very high-risk behaviors and dangerous.” behaviours.”
“There’s a tendency, in a way, to watch and wait and deprive these children of their priority for the most severe, and then there’s a tendency to get worse,” he said, adding that public hospitals may be reluctant to admit them. because inpatients are uncomfortable.
“In many ways, these kids are actually harder to treat,” he said.
The JAMA research found that overall visits to pediatric emergency departments for mental health crises increased by 43% from 2015 to 2020, increasing an average of 8% per year, with an increase in emergency visits for each mental illness category. By comparison, emergency room visits for all medical reasons increased by 1.5% per year.
About a third of visits were related to suicidal ideation or self-harm, and about a quarter of patients presented with mood disorders, followed by anxiety disorders and impulse control disorders. About 13% of patients revisited within six months.
“It causes a lot of moral distress for many of us, as we don’t always think the emergency room is the right place or the best place to care for most of our patients,” Cushing said.
“But,” he added, “they really have nowhere else to go.”
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