Research sheds light on ER mental health visits

(Edmonton) Medical researchers from the University of Alberta who reviewed pediatric visits to emergency departments over six years discovered that those most apt to seek help for mental health concerns were First Nations children and kids from low-income families.

“These findings can help us ask more pointed questions in terms of what we can do for these children,” says Amanda Newton, the principal investigator of the research findings published June 11 in the Canadian Medical Association Journal.

“Why are these visit rates higher than for other children? And what can we do about it?” she says. “It does make you wonder what these children are not getting on a regular basis from the community, and what circumstances lead up to an emergency department visit.”

Newton, a researcher with the pediatrics department in the Faculty of Medicine & Dentistry, worked with colleagues in Ottawa and Halifax, and with two colleagues in her faculty—Rhonda Rosychuk, also in the Department of Pediatrics, and Kathryn Dong from the Department of Emergency Medicine.

They reviewed pediatric visits to emergency departments in 104 Alberta hospitals between 2002 to 2008, which amounted to more than 30,000 visits by nearly 21,000 children.

Although First Nations children comprised six per cent of the province’s pediatric population at that time, they accounted for nearly 14 per cent of the pediatric ER visits for mental health concerns. Children from low-income families comprised 17 per cent of Alberta’s pediatric population, but accounted for more than 25 per cent of the pediatric visits to emergency departments for mental health care.

The research also revealed that it took an average of 79 days before First Nations children received followup care with a physician after their emergency department visits. First Nations children and kids from low-income families were also more likely to return to emergency departments sooner.

“I think some of them are falling through the cracks, but I don’t think there’s one reason for that,” says Newton. “It could be health-care system issues, a lack of access to specialized services, not knowing where to go for care, or family factors such as a reluctance to talk about mental health issues, which can then escalate to a crisis situation.”

Earlier intervention is needed to prevent mental health concerns from reaching crisis mode, say the researchers. Investing in programs that target high-risk behaviour could be one solution, they say.

“There may need to be a study about what happens before they get to emergency,” says Newton. “How do these children get to a point where they need to go the emergency department in the first place? Do they need different community-based services?”

The U of A research team also found that more girls than boys visited the emergency department for mental health concerns, and that those between ages 15 and 17 were most likely to seek access to emergency care for mental health issues, compared with children of other ages. The most common mental health concerns for ER visitors were anxiety, stress or substance abuse.

The research was funded by the Canadian Institutes of Health Research.