Families are increasingly turning to emergency departments for help when their child is experiencing a mental health crisis. A study of Illinois emergency departments published in the Journal of American College of Emergency Physicians Open found that while hospitals across the state are making strides in caring for these children, they still face significant challenges, especially limited access to specialists and long wait times for psychiatric treatment. Emergency departments surveyed also suggested practical solutions, including investments in real-time bed tracking to improve mental health staffing, treatment activities, and coordination of mental health resources.
Hospitals told us what they needed: better access to mental health professionals, tools to support children while they waited, and systems to easily connect children to the right level of care. Our findings provide a roadmap for improving pediatric mental health emergency care. ”
Jennifer Hoffman, MD, MSc, first author, emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine
The study included 65 emergency departments across the state participating in the Illinois Children’s Facility Accreditation Program, which supports pediatric emergency response based on core requirements. Established in 1998, the Illinois program was one of the first in the nation to achieve state regulatory designation for pediatric emergency care. Approximately half of Illinois emergency departments participate. As of 2023, 23 states have similar pediatric certification programs in place.
The study found that nearly two out of three emergency department visits were in hospitals without pediatric inpatient units, highlighting that many children receive mental health emergencies in non-pediatric hospitals. Approximately one in five emergency department responses were in critical access hospitals, representing areas where access to pediatric mental health professionals is particularly difficult.
Dr. Hoffman and colleagues found that only 56% of emergency departments reported having a mental health professional on-site. An additional 44% reported using telehealth services.
“We found that a critical gap in emergency care was access to timely evaluation by mental health professionals, particularly those with pediatric-specific expertise,” Dr. Hoffman said.
One of the biggest barriers to optimal care for children with behavioral and mental health problems, identified by 81% of ED visits, was limited availability of post-visit services, such as continuing care in the community or psychiatric hospitalization. This often results in long wait times in the emergency department, which 70% of respondents cited as a major challenge. More than three-quarters of emergency department visits reported that at least one child had to wait more than three days to receive needed psychiatric treatment within the past year.
“A child experiencing a mental health crisis should not have to wait days in the emergency department to get the care they need. A child with a broken leg should never have to wait three days for surgery. The same standards should apply to children with mental health needs,” Dr. Hoffman said.
Emergency departments varied in their implementation of best practices for caring for children at risk of suicide. Eighty-eight percent of emergency departments reported screening children for suicide risk, regardless of the reason for their visit. However, only about half (56%) consistently followed family-recommended steps to protect children from self-harm at home.
“It’s encouraging that most emergency departments screen children for suicide risk,” Dr. Hoffman said. “The next challenge is to ensure that families arrive at the emergency department with a clear plan to keep their child safe and get help.”
Emergency departments highlighted specific resources that can immediately improve the experience and quality of care for children and families.
- 82% want safe activities and games to help kids cope with waiting times
- 73% wanted real-time information about available pediatric psychiatric beds across the state.
- 72% wanted a case manager to help connect families with follow-up care
- 65% wanted a mechanism for escalating cases where staff have difficulty finding a suitable placement for a child
“These findings highlight important differences in the processes and resources for pediatric behavioral health care across emergency departments, along with common barriers and clear opportunities for improvement,” said Michelle M. Burns, M.D., president of the Illinois Chapter of the American Academy of Pediatrics. “The Illinois Chapter of the American Academy of Pediatrics is committed to advancing efforts to strengthen mental health care delivery and better support children and families across the state.”
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Ann & Robert H. Lurie Children’s Hospital of Chicago
