There is no one-size-fits-all solution. At least part of the solution will be to decrease the number of children presenting to the ED for mental health crises. 

“We need to ensure that youth are aware of a new national 988 crisis hotline,” Dr. Hoffmann said. “Many children could be linked to community services and not require emergency visits.”

There are also emerging models of mobile mental health services that physically go to the location where a child is in crisis, whether that is at home or at school. 

“These are only available in certain geographic areas but hold a lot of promise to reducing ED visits,” Dr. Hoffmann said. “There are also emerging models of psychiatric urgent care or walk-in clinics where patients can receive same-day services that could reduce emergency visits.” 

Additionally, Dr. Hoffmann said there are emerging ED diversion models in which ambulance crews have pre-set criteria to bring patients directly to freestanding psychiatric facilities instead of the ED.

Once a patient is in the ED, emergency physicians must try to improve and not exacerbate mental health symptoms. Dr. Herman said an important step in minimizing the issue will be an increase in psychiatric training for emergency physicians. “Emergency physicians will have to become more comfortable initiating treatment in the ED,” Dr. Herman said. This might include obtaining training in verbal de-escalation or trauma-informed care. 

Use of brief interventions, such as the Safety Planning Intervention, have been shown to be effective in adult EDs, reducing return visits by as much as 43 percent, with emerging evidence showing they may be effective for children as well.^6,7

“There is also a move toward self-guided digital mental health interventions deployed within the ED,” Dr. Hoffmann said. 

Dr. Snow said that Boston Children’s has an in-patient psychiatric unit embedded within its hospital and has opened two additional off-site locations with psychiatric beds. 

“Obviously that requires a ton of additional hiring, training, and support to create those facilities,” Dr. Snow said. Within the hospital, a lot of additional staff has been added including psychiatrists, social workers, and others who can help triage these admissions and at least do some level of check-in everyday while they board. 

One thing remains clear, though. More attention on the problem and more potential solutions are sorely needed. Indeed, incoming ACEP President L. Anthony Cirillo, MD, said that the health care community “cannot continue to celebrate getting a 59-year-old STEMI patient to the cath lab in less than 30 minutes when a nine-year-old suicidal patient has been sitting in the ED for 30 days waiting for an inpatient psychiatric bed.”