Kids, Mental Health, and Emergency Care
Kids, Mental Health, and Emergency Care
This is based on the journal article Pediatric Mental Health Care in Emergency Departments: A Review of the Literature by Kadian Magerl and Beth Swan, published in Pediatric Nursing in 2025. All statistics and references are found in the references list of their article.
The United States is seeing a significant increase in mental health crises among children, affecting one in five kids each year. Because there are not enough pediatric mental health providers—70% of counties do not have a specialist—families often turn to emergency departments (EDs) for help. This puts extra pressure on EDs, which usually do not have the right facilities or staff for pediatric psychiatric care.
Common ED-specific challenges include a shortage of pediatric psychiatric beds, gaps in staff training on mental health protocols, and difficulties maintaining a safe environment for both patients and providers.
Recent studies show that mental health conditions make up almost 46% of pediatric medical spending, which is about $90 billion each year. Over the past decade, EDs have seen a 325% jump in cases of self-harm and a 117% increase in anxiety disorders among children. As a result, EDs face challenges like longer boarding times, more medication errors, and greater safety risks for staff. New care models, including integrated crisis teams, structured clinical pathways, and telepsychiatry, have shown they can shorten stays, improve safety, and make the patient experience better.
The increase in psychiatric patients has changed how EDs usually work and brought new safety and quality-of-care risks.This surge causes longer wait times, longer stays, and higher costs. Children with mental health needs often have higher triage scores and are more likely to experience delays in care.
Medication Errors: A retrospective review identified 974 medication errors among 491 pediatric MH patients during
ED boarding; 18% of these errors resulted in severe consequences.Visits to low-volume EDs increased by 53%, and to non-metropolitan hospitals by 41%, showing the crisis extends beyond urban areas.Providers often feel frustrated by system barriers, a lack of clear protocols, and the impact that psychiatric boarding has on care for other patients.
To address these daily frustrations, providers can take immediate steps such as forming quick team huddles at the start of each shift to discuss high-risk cases and share updates on protocols. Using standardized checklists for pediatric mental health cases can also help ensure consistency and reduce uncertainty. These small but practical actions can empower clinicians and improve workflow even in challenging environments.
Studies about what patients and families go through show that many are unhappy with how traditional EDs handle mental health care:Families mention lack of privacy and the use of restraints or surveillance as key distress sources.Adolescents often say they feel judged by ED staff and believe providers are not ready to handle pediatric mental health cases.Patients point out that inconsistent care and long wait times are major barriers to getting effective treatment.
To fix these problems, several new care models have been tried and studied.To make progress, we need to review current research and suggest a coordinated, multi-step plan to stabilize and improve pediatric mental health care in emergency settings. Key priorities for clinicians include: participating in ongoing training in pediatric mental health protocols, adopting standardized screening and clinical pathways, advocating for additional staffing and resource allocation, utilizing telepsychiatry or virtual consultation services as appropriate, and collaborating with community partners to strengthen crisis response options. By focusing on these key steps, providers can help create safer and more effective care environments for children in crisis.It is urgent for different sectors to work together to increase funding for pediatric mental health services, expand psychiatric resources, and encourage more people to join the workforce.
Emergency providers require robust, ongoing training in:Pediatric MH triage and risk assessment. Evidence-based de-escalation techniques.Trauma-informed care practices. The use of standardized screening tools, including: the ASQ for suicide risk screening, the PSC to identify broad psychosocial concerns, and the GAIN-SS for screening co-occurring substance use or mental health disorders.
Telepsychiatry is an important way to close access gaps. It helps provide timely assessments during off-hours or in places where there are not enough specialists.Strengthening the first steps in care, like mobile crisis teams and PMHCA, helps prevent too many ED visits by supporting primary care providers and schools.Telepsychiatry gives hospitals without on-site psychiatric specialists a flexible solution that can grow to meet their needs.Virtual consultations allow for remote psychiatric evaluations and real-time help, which is especially useful in rural or low-volume areas.Real-World Impact: This approach helps close geographic access gaps and has been shown to reduce the average ED stay to 7 to 9 hours
Mobile EMS Triage & Alternative Destination Protocols: This model focuses on early action, letting EMS assess risk in the field, often at schools or homes, before deciding if hospital transport is needed.Mechanism of Action: Field providers follow special protocols to decide if a child can safely go to a community-based stabilization center instead of the ED.Real-World Impact: This reduces unnecessary ED visits and helps make sure children get care in the least restrictive setting possible.
Structured Clinical Pathways
Clinical pathways use evidence-based, structured workflows instead of ad hoc care for psychiatric cases.Validated tools such as ASQ, PSC, and GAIN-SS make it possible to use pre-printed orders and standardized documentation. Real-World Impact: This improves triage accuracy and helps identify high-risk patients early in their visit.These tools work best when they are used together in a single, unified care system.——————————————————————————–
Data show that shifting from reactive emergency management to more structured, innovative approaches leads to clear improvements in clinical outcomes and hospital operations.
Improvement Length of Stay (LOS) Workflow initiatives led to an average86-minute reduction in total ED stay
Patient Safety Significant reduction in medication errors (previously at 72.7%) and decreased injuries from behavioral escalation.
Assessment Volume On-site psychiatric units saw assessments jump from91 to 226 cases without disrupting standard ED flowHospital CostsSavings of35–49 per visit achieved by reducing reliance on one-to-one sitters
Care Continuity Standardized pathways guaranteed outpatient follow-up within 24 hours to 7 days
These results show that standardized, specialized care is both more compassionate and more efficient for the healthcare system.To get better results, EDs and policymakers should focus on three things: making big investments in pediatric mental health infrastructure, expanding and combining interdisciplinary care models, and using trauma-informed, age-appropriate care for all children.
Magerl, K. K., & Swan, B. A. (2025). Pediatric mental health care in emergency departments: A review of the literature. Pediatric Nursing, 51(6), 267. https://doi.org/10.62116/pnj.2025.51.6.267