Children with Outpatient Mental Health Care Still Face ER Visits

Even with regular treatment from mental health professionals in an outpatient setting, many teens and children with psychiatric and behavioral challenges still wind up visiting the emergency room more often than their healthy counterparts. According to a new study that looked at the medical records of children between the ages of 3 and 17, nearly 12 percent had multiple visits to the ER. The data, collected at the John Hopkins Children’s Center emergency room, indicated that most of the trips to the ER were the result of either negligible mental health crisis, or minor behavioral issues. There were very few occasions that children were treated repeatedly for serious psychotic episodes (3%) or attempted suicides (10%). The researchers discovered that nearly two thirds of the children listed that they had a mental health clinician at the time of the first episode. And even more, nearly 85% said that they were seeing a mental health care provider when they returned to the ER. The researchers question if the outpatient care being provided is adequately helping the children. They note that most emergency rooms do not offer sufficient staff and tools available to act as effective mental health facilities.

“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. “We need to understand why families who are already connected to outpatient providers continue to seek ER care, why providers send patients to the ER and what role, if any, ER’s may play in the continuum of care for non-psychotic, non-suicidal patients,” she said. “Perhaps the most critical questions to ask are ‘When was the child’s latest outpatient visit?’ and ‘What exactly transpired between that visit and their subsequent trip to the ER?’” said Frosch.

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • janie


    June 7th, 2011 at 4:28 AM

    There are precious few resources available for mental health treatment as it is. To think that ERs could have the funding to have mental health support staff available all of the time is nothing ut a pipe dream. Yes it needs to happen but with hospital funding the way that it is I think that we all know that this is not anything that will happen anytime soon. It makes me sad to see that these children are still having to endure these visits and yet are still seeking help the best way that they know how.

  • PK


    June 7th, 2011 at 11:46 PM

    Just seeing a therapist is not nough and this little information can be quite misleading without the entire picture.We need to see when they started seeing the therapist and how often they see the therapist because let us be honest here-you cannot expect result after one or two visits to the therapist and even after a substantial number of sessions,it’s not like magic that you are treated with.It takes time and effort from the patient’s side too.

  • Cody


    June 8th, 2011 at 1:37 PM

    Could it be that these patients are also on some kind of medication in addition to the therapy? Pharmaceuticals can really bring in the need for ER visits…!

  • Katherine O’Neil

    Katherine O’Neil

    June 11th, 2011 at 10:11 PM

    Of course they will still face ER visits. If you have psychotic episodes or you attempt suicide, you’ll wind up in the hospital because of it. You can’t really change the fact that some children can be very difficult to help within the confines of an ER facility. And they can’t exactly time when it will happen so it coincides with their outpatient provider visit.

    The hospitals do need to make more provisions for these types of cases.

  • Frank Goss

    Frank Goss

    June 11th, 2011 at 11:26 PM

    If any ER staff member thinks even for a moment that a physician isn’t giving the medical care needed to a child patient, they need to report it to the hospital administrator. Either the physician can’t do it, or they need different care. Those are the possibilities you’re left with when it doesn’t work.

  • Cheri D.

    Cheri D.

    June 12th, 2011 at 10:59 PM

    @Frank Goss – Not true. The ER physician can only work with the tools he has. As is stated: “They note that most emergency rooms do not offer sufficient staff and tools available to act as effective mental health facilities.”

    Don’t blame the doctors who are already doing a very hard job! They could well know what the problem is and simply not have access to the resources they need in their ER.

    I suggest you write to your Congressman, give him the link to this article and ask him to investigate this sorry state of affairs further rather than pointing the finger at the physicians.

  • Jordan Adams

    Jordan Adams

    June 13th, 2011 at 12:00 AM

    “The data, collected at the John Hopkins Children’s Center emergency room, indicated that most of the trips to the ER were the result of either negligible mental health crisis, or minor behavioral issues.”

    Minor behavioral issues? Who takes their child to an ER for a minor behavioral issue? Good grief, don’t their parents have an ounce of common sense? There are men and women DYING in there while you’re wasting a doctor’s time!

    ER=Emergency Room. Emergencies only! How selfish and irresponsible.

  • cole grant

    cole grant

    June 13th, 2011 at 1:40 AM

    When teenagers exhibit suicidal behavior, we need to look at their homes and schools as well. Abusive parents or trouble at school can drive a teenager to suicide with alarming ease.

    Teenagers don’t become suicidal over nothing or overnight. There could be more coordinated sharing of information between the outpatient provider and the ER about any visits to prepare them both for future instances.

  • Armando Hill

    Armando Hill

    June 13th, 2011 at 9:31 PM

    @JordanAdams–Exactly! And why oh why don’t the ER’s tighten up who they see if there are children being brought in for issues that could easily wait until they get an appointment to see their doctor? I’d bet my bottom dollar that the parents the types that demand immediate gratification, whether it’s fast food, a checkout queue or healthcare. Not for them waiting for an appointment like everyone else.

    Treble or quadruple the charges related to seeing an ER doctor if you go and it turns out to be a non-emergency. Their insurance companies will be quick to tell them to stop doing it or raise their premiums. That’s one way to eradicate that nonsense.

  • Les Hart

    Les Hart

    June 18th, 2011 at 9:04 PM

    @janie—We need to find out where the money hospitals get is going, how much is profit, and how much is being wasted. I can’t believe that the money isn’t available somewhere to fund mental health more.

    I feel it’s more likely to be money mismanagement that is the problem once the hospitals get said funding. Mental health is always last to receive funding and the first area they choose to cut.

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Title   Content   Author is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on