Emergency Rooms See Increase in Black Youth Seeking Psychiatric Treatment

Doctors report they are treating more and more children suffering from psychiatric emergencies—but for Black children accessing mental health care remains complicated.

A new joint report from three leading medical associations warns that across the United States, emergency rooms are being packed with children who need treatment for a psychiatric emergency like anxiety, depression and suicidal thoughts or attempts.

The report was published in August in the journal Pediatrics and explains that this sudden surge in pediatric mental health emergencies has overwhelmed ERs in the United States, says the joint paper from the American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA).

“Unfortunately, the kids coming to the ER are less likely to receive the ongoing mental health care they truly need,” said lead author Dr. Mohsen Saidinejad, director of pediatric emergency medicine at the Ronald Reagan UCLA Medical Center.

“The ER has become a de facto referral center for all of these problems, and there’s too many of them for the emergency department to manage,” said Saidinejad, a member of the AAP and ACEP committees on pediatric emergency medicine. “That is not who we are as ER physicians. We are not mental health professionals. We cannot provide definitive care.

“We can screen, we can identify those at harm risk, but that’s about it, so the ER is really not the most appropriate place to manage these cases,” Saidinejad said. “And I think we are becoming that because there isn’t any other place for these kids to be sent.”

Every year, about half a million children with mental and behavioral health problems are evaluated in ERs, the joint report says. According to the report ER visits involving mental health problems increased by 120 percent at children’s hospitals between 2007 and 2016. In addition, the rate among general hospitals rose by 55 percent during the same period.

Experts say the pandemic is a key factor that intensified this mental crisis, Dr. Madeline Joseph, a pediatric emergency physician at University of Florida Health in Jacksonville said.

In 2021, U.S. Surgeon General Dr. Vivek Murthy released an advisory that warned of the growing mental health crisis among children, declaring it a national emergency.

“We have witnessed firsthand the dramatic increases in Emergency Department visits for all mental health emergencies, including suspected suicide attempts,” said Joseph, an ACEP spokeswoman.

Black children have also experienced and increase in mental health hospitalizations and treatment. Research conducted by the JAMA Network details a growing mental health crisis among Black youth. Between 1991 and 2019, Black adolescents had the highest increase among any racial or ethnic group in prevalence of suicide attempts — a rise of nearly 80 percent. 

About 53 percent of Black youth reported experiencing moderate to severe symptoms of depression, and about 20 percent said they were exposed to racial trauma often or very often in their life. Yet, because of various reasons including structural and socioeconomic inequalities, Black adolescents are far less likely than their white peers to seek and find mental health care.

According to JAMA Network, suicide ideation and attempts are also prevalent among Black youth. However, few studies have examined the mechanisms underlying suicide attempts in Black adolescents. The Network suggests that because Black children continue to experience racism at an early age, the lived experiences of Black youth often involve trauma that is untreated. A Centers for Disease Control and Prevention survey found that 22 percent of Black youth had considered suicide in the past year.

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