Adult emergency departments are overwhelmed with mental health visits, and the problem worsens every year. There are many explanations, but the most basic is that we are missing opportunities to intervene before patients have mental health crises.
A December 2017 report from the National Survey on Drug Use and Health shows the percentage of adults with mental illness was essentially unchanged from 2008 to 2016.
However, a 2016 brief from the Healthcare Cost and Utilization Project showed that emergency department visits for common behavioral health issues increased more than 50% from 2006 to 2013.
We are failing, then, to intervene before an adult reaches the emergency department, and many missed opportunities actually come in childhood.
Half of lifetime mental illness begins before age 14, and only half of children with a mental health disorder receive treatment of any kind.
Beyond the impact on the adult healthcare system, we see consequences of pediatric behavioral health conditions throughout society. Suicide is the second-leading cause of death for youths age 10 to 19. A 2015 JAMA Psychiatry study found children and adolescents with behavioral health conditions were significantly more likely to drop out of high school and have difficulty keeping a job later in life. They also experience residential instability, multiple substance addictions, early parenthood and incarceration at far higher rates than their peers.
If we hope to make a change in these outcomes—and if we want to reduce the burden on the adult system—we must make a greater investment in pediatric behavioral healthcare. Our experience at Nationwide Children's Hospital shows that every time we have expanded services in the past five years, we have been met with greater demand.
We had 142,182 outpatient behavioral health visits in 2013. By the end of 2017, we were on track for more than 220,000 visits. We began an emergency psychiatric evaluation center in 2014 and had 1,379 visits the first year; in 2017, that number was expected to top 4,400. A new inpatient unit opened in 2015 and the unit has been full from the very first week it opened its doors.
So Nationwide Children's is expanding its services again. We broke ground in 2017 on the Big Lots Behavioral Health Pavilion, which will be the largest center of its kind on a pediatric medical campus when it opens in 2020.
We are doing this for a few reasons. As a hospital and an anchor institution in a community, we have an obligation to these children and their families. Physical health and mental health are linked. Behavioral healthcare is healthcare. To prove that, though, we must invest in behavioral health the way we do in physical health.
One of the great challenges for any system is the low reimbursement rates for those services, which lead to more out-of-network care as well as a shortage of specialists. With current metrics for successful behavioral health treatment being so subjective, the argument for improved reimbursement becomes stronger if providers develop better protocols and measures.
We also want to break down the stigma preventing that investment. Hospital systems are more interested in a reputation based on "prestige" programs such as gene therapy and cardiac surgery than on behavioral health services. While prestige programs are important, we all want a future with fewer suicides, reduced homelessness and less strain on the healthcare system. Greater investments in behavioral health, especially in pediatric settings, can help make that future a reality.
