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ER visits persist for children with mental health problems despite regular outpatient care
Date:5/31/2011

Johns Hopkins Children's Center scientists have found that having a regular outpatient mental health provider may not be enough to prevent children and teens with behavioral problems from repeatedly ending up in the emergency room. The study is published in the June 1 issue of the journal Psychiatric Services.

Analyzing more than 2,900 records of pediatric patients, ages 3 to 17, treated at the Hopkins Children's ER for mental health crises over eight years, the investigators found that 338 of them (12 percent) returned to the ER within six months of their initial visit. The majority of the ER visits stemmed from behavioral problems or minor psychiatric crises, such as disruptive classroom behavior, verbal altercations and running away, the researchers said. Only a few involved severe psychotic episodes (3 percent of the visits) or suicide attempts (10 percent). Most importantly, the researchers found, two-thirds of patients (220) reported having an outpatient mental health provider at both visits, and 288 (85 percent) reported at the second visit that they have a regular mental health provider.

The findings are concerning, the researchers said, because they may signal that patients are not actually getting the care they need on an outpatient basis.

Mental health experts have traditionally emphasized the importance of outpatient care in managing non-emergency cases and have urged connecting such patients to outpatient mental health programs. Most ERs are neither designed nor staffed to deliver effective, coordinated mental health care, the investigators said.

"We think of the ER as a 'front door to care,' but our findings suggest otherwise as a significant number of patients repeatedly seek care in the ER despite being connected to an outpatient provider," said lead author Emily Frosch, M.D., a pediatric psychiatrist at Hopkins Children's.

The findings, Frosch said, raise more questions than they answer, and
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Contact: Kim Hoppe
khoppe1@jhmi.edu
410-502-9430
Johns Hopkins Medical Institutions
Source:Eurekalert

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