The study analyzed emergency department visits among children ages 5 to 17 who received a primary mental health diagnosis, using the Nationwide Emergency Department Sample database. In total, the analysis captured more than 5 million emergency visits for mental health concerns by U.S. children over the six-year study window, making it one of the most comprehensive portraits to date of how pediatric mental health crises flow through the American emergency care system. All pediatric mental health-related emergency visits increased by 24 percent during the study period, but suicide-related visits climbed nearly three times faster, rising 74 percent.

The diagnostic breakdown reveals where the burden is concentrated. The most frequent mental health diagnosis groups were suicide or self-injury, accounting for 24 percent of visits, and depressive disorders, accounting for 23 percent. Together, these two categories made up nearly half of all pediatric mental health emergency presentations, underscoring that suicidal thoughts and self-harm have become the single most common reason children arrive at emergency departments in psychological crisis. For clinicians and health systems, the trend signals a shifting caseload that many facilities were never designed to handle.

Perhaps the most striking structural finding concerns where these visits occur. About half of suicide-related emergency visits, and half of all children’s mental health emergency visits, took place in hospitals with lower pediatric volume, defined as fewer than 10,000 pediatric visits annually. A child experiencing a mental health crisis may arrive at any emergency department, the study authors noted, and many of these community hospitals are simply not prepared to care for children with acute mental health needs. Unlike large freestanding children’s hospitals, these facilities often lack dedicated psychiatric staff, child-specific protocols, and inpatient mental health beds.

The consequences of that gap are measurable. At emergency departments with the lowest pediatric volume, close to 30 percent of children seen for mental health conditions had to be transferred to other hospitals to receive definitive care. Such transfers are far from benign. Dr. Jennifer Hoffmann, senior author of the study and assistant professor of pediatric emergency medicine and medical social sciences at Feinberg, described the toll that waiting for a transfer imposes on families. Transfer to another hospital for pediatric mental health care often means a prolonged wait in the emergency department, sometimes lasting days, she said, increasing the burden on children and their families. During that interval, children in crisis may remain in crowded emergency settings without specialized psychiatric supervision.

Hoffmann emphasized that practical resources already exist to narrow this gap. Emergency departments across the country can access the New England Regional Behavioral Health Toolkit, as well as the National Pediatric Readiness Project, both of which offer free, evidence-based guidance for improving care for children, including youth with mental and behavioral health conditions. Toolkits are readily available to help emergency departments care for children with mental health needs, especially while kids wait for a transfer to another facility, she said. The hope is that better preparation at the point of first contact can stabilize children faster, shorten stays, and reduce the cascading stress that prolonged emergency boarding creates for young patients and their caregivers.

The study also surfaced significant disparities in where different groups of children receive care. Indigenous children were more likely to arrive at emergency departments with lower pediatric volume, meaning they are disproportionately likely to encounter facilities with fewer pediatric mental health resources. Youth with substance use concerns were also seen more often at lower-volume emergency departments. These patterns suggest that the children who already face elevated risks and structural barriers to care are, in many cases, being treated in the settings least equipped to meet their needs, compounding existing inequities in youth mental health outcomes.

Lead author Dr. Audrey Brewer, assistant professor of advanced pediatrics and primary care at Feinberg and a pediatrician and researcher at Lurie Children’s, argued that the findings demand a system-wide response rather than isolated fixes. Our findings underscore the need to equip every emergency department, not only large pediatric centers, with tools and resources to provide evidence-based mental health care, she said. Strengthening mental and behavioral health capacity across all emergency care settings is essential to ensuring children receive timely, effective and equitable care. In practice, Brewer said, that means all emergency departments need additional training and access to pediatric mental health professionals, whether onsite or via telehealth, as well as reliable linkage to follow-up care after discharge.

Brewer also called for a fundamental change in screening practice. Every emergency department, she said, should offer universal suicide screening for children, regardless of whether they arrive with a mental health concern, since suicidal thoughts may be present even when the chief complaint is a physical injury or illness. When concerns are identified, emergency departments should provide families with a clear plan to help keep their child safe at home, including means restriction and follow-up arrangements. Universal screening represents a low-cost intervention that could identify risk in children who would otherwise slip through unnoticed, but it requires training, standardized tools, and workflows that many smaller departments currently lack.

Beyond the emergency department itself, the authors pointed to the need for interventions designed for the full diversity of the pediatric population. To improve care, emergency department-based mental health interventions need to be developed and tested for children of color, since many have not been studied in diverse populations, Brewer said. Delivering culturally responsive, evidence-based interventions for children in the community and in outpatient primary care settings can help to potentially lessen emergency department reliance for mental health care and may help reduce disparities in youth mental health outcomes. As suicide-related emergency visits continue their steep climb, the study makes clear that the response cannot rest solely with a handful of specialized children’s hospitals; it must reach every emergency room in the country where a child in crisis might walk through the door.

Subject of Research: Pediatric suicide-related emergency department visits and emergency care capacity in the United States

Article Title: Children’s suicide-related emergency visits spiked by 74% in the US between 2016-2022

Article References: Children’s suicide-related emergency visits spiked by 74% in the US between 2016-2022. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: suicide-related visits, pediatric mental health, emergency department, children, Northwestern University, Lurie Children's Hospital, Annals of Emergency Medicine, suicide screening, health disparities, hospital transfers, pediatric readiness, youth mental health crisis