Mental health-related ER visits increasing at Nashville, TN Children’s Hospital

NASHVILLE, Tenn. (WKRN) — Amid a growing national crisis, psychologists at Monroe Carell Jr. Children’s Hospital at Vanderbilt are seeing an increased number of kids visiting the emergency department for mental health conditions.

Katherine Spencer, PsyD, HSP, Assistant Professor of Clinical Pediatrics at Monroe Carell in Nashville, works with children with a variety of behavioral health concerns and co-existing mental health conditions every day.

In the last 10 years, Spencer said she and other psychologists have seen an “alarming” increase in children with conditions like anxiety and depression reaching crisis levels. Many of their patients have injured themselves or are experiencing co-existing medical conditions.

“It had been on the rise even before the pandemic and unfortunately a lot of children and families experienced a lot of adverse childhood events, a lot of challenges during the pandemic, like many of us,” Spencer said. “And it was like salt in the wound. It got worse.”

Already high numbers spike during pandemic

During the COVID-19 pandemic, Spencer said there were several children with diagnosed mental health conditions who could not access regular outpatient therapy, leading more of them to the emergency room during psychiatric emergencies.

According to data from the Centers for Disease Control and Prevention (CDC), between March and October 2020, the proportion of mental health-related visits to emergency departments increased by 24% among children aged 5 to 11 years and 31% among children aged 12 to 17 years.

While businesses began reopening and many operations returned to normal the following year, Spencer said some of the facilities that previously offered resources for children and families with mental health diagnoses in Tennessee did not open back up.

“In our communities there have been inpatient psychiatric facilities that have closed or are not able to accept children with specific diagnoses,” she said. “And it’s really challenging for families and providers when they can’t access the level of care that would typically be recommended.”

In 2021, several pediatric health organizations declared a national emergency for children’s mental health. Between February and March of 2021, emergency room visits for suspected suicide attempts were up 51% compared to the same period in 2019, according to the CDC.

Recent CDC data from 2022 shows that emergency department visits among children have not slowed, and Spencer said the same impacts can be seen at Monroe Carell.

“We continue to lack some of the resources that would be incredibly beneficial for these children on an outpatient level,” Spencer said. “So, we have continued to see higher numbers that have not necessarily decreased.”

Conditions driving kids to the emergency room

Heightened anxiety has been a common issue driving many children to the emergency room, along with increased aggression and self-harm or suicide attempts.

In a separate interview, Dr. Kelsey Gastineau, MD FAAP, pediatric hospitalist at Monroe Carell said there is likely a link between “this epidemic of mental health crises” and an increased number of children being treated for gun injuries, including suicide attempts.

“We as pediatricians are seeing more and more firearm injuries coming in,” she said. “But we’re also seeing more and more children with mental health crises coming into our outpatient clinics, our emergency departments and in our hospitals, and those things are absolutely linked.”

Spencer said she also sees many patients with neurodevelopmental disorders like autism who have co-existing mental health conditions. Some of her patients are also facing crises brought on by conditions like obsessive compulsive disorder.

By the time they’ve reached the emergency room, most children are in severe crisis. Again, Spencer said part of this may be because families feel like they have nowhere else to turn.

“Families aren’t seeking crisis (services) if they feel like they have adequate resources locally,” she said. “If the recommendation is inpatient psychiatric hospitalization that really would mean that they’re at risk for harming themselves or others imminently or could not be managed outside of a hospital.” 

Numbers higher among young girls

Particularly concerning has been a disproportionate increase in the number of young girls visiting emergency departments for mental health conditions, Spencer said. According to the CDC, girls aged 12 to 17 accounted for the largest increases in the number of hospital visits between 2019 and 2022.

The CDC noted an increase in girls with anxiety, eating and tic disorders and obsessive-compulsive disorders. At Monroe Carell, Spencer said psychologists have also seen an increase in the numbers of young girls coming in with suicidal ideation or significant self-injury.

“I think the pre-teens and teenagers are at a very vulnerable age and unfortunately there’s a lot of access to things that can potentially be very traumatic or potentially contribute to these young girls feeling bad about themselves, their body image, their life,” Spencer said.

Each child who visits the emergency room is assessed by a team of specialists to see what level of care would be most appropriate. Those who are not in need of intensive treatment like inpatient hospitalization are typically connected with outpatient therapy.

Meeting the demand for services

While there still may be wait times, Spencer said providers in Tennessee are trying to meet the need for mental health services with Mobile Crisis Services. The Statewide Crisis Line connects children and families with several agencies like Nashville’s Mental Health Cooperative.

Trained crisis specialists can then provide mobile services like telehealth assessments, stabilization of symptoms and referrals for additional services and treatment. However, in order to meet the demand for mental health services, Spencer said more providers are still needed.

“I think it’s important for us at different levels to really advocate for children’s mental health services,” she said. “I know there are many therapists, psychologists entering our workforce, but we need more. Our rate of mental health emergencies in children is well beyond the increase in access to mental health care right now.”

Families can help support their children by encouraging them to exercise, sleep well and take part in extracurricular activities. Spencer said it is also important to give children the space to talk about stressful situations, especially amid major tragedies.

The Statewide Crisis Line at 855-274-7471 is available 24/7 for anyone experiencing a mental health emergency. Tennesseans can also call or text 988 to reach their local call center for the National Suicide Prevention Lifeline.