Trends in mental health and chronic condition visits by children presenting for care at US emergency departments

The purpose of this study was to compare the burden of mental health disorders to the burden of other chronic care conditions as measured by emergency department (ED) visits by children with respect to prevalence rates, time trends, and hospital admission rates. Data from the 1995-2001 National Hospital Ambulatory Medical Care Survey were used to assess the number of visits to emergency departments by children with a diagnosis of a mental health or chronic condition, a mental health-related reason for the visit, or a prescription or continuation of psychotropic medication. From 1995 to 2001, there was an increase in the proportion of visits by children with mental health problems. During the same period, the proportion of visits by children with chronic illness appeared stable. Overall, mental health diagnoses made up approximately 5% of all U.S. emergency department visits by children, similar to the percentage of total visits for other chronic conditions (5.2%). Approximately 15% of visits in both the mental health and chronic condition groups ended in hospital admission compared to less than 5% in the overall group of ED visits by children. The burden of mental health related visits to U.S. EDs is growing at a faster rate than visits related to chronic conditions. Visit intensity, hospital admission, and medication utilization is just as intense as that for chronic conditions. Promoting provider mental health training and restructuring the ED visit to allow for rapid mental health assessment and immediate onsite or contiguous mental health care may be one way to improve outcomes for families and to position the ED as part of a larger integrated system of effective mental illness care.