ABSTRACT

Introduction: Psychiatric emergency department (ED) visits among youth have risen in the United States in recent years. A major factor contributing to this increase is the lack of accessible inpatient and outpatient services, making the ED a safety net for mental and behavioral health emergencies. This study sought to assess outpatient mental and behavioral health care after ED discharge and understand barriers and facilitators that caregivers encounter when attaining outpatient care. 

Methods: This was a mixed methods study conducted at a tertiary care pediatric ED. Patients ages 3 to 17 years seen for mental health concerns received a social work consult and were contacted 1 week after the ED visit by the mental and behavioral health navigator as part of ongoing quality improvement efforts. Descriptive data included types of outpatient care received, demographics, and repeat ED visit within 30 and 60 days. Results were analyzed via logistic regression. Patients’ caregivers also were interviewed 4 weeks after the ED visit to explore barriers and facilitators to accessing outpatient care. Thematic content analysis was then performed. 

Results: The navigator successfully reached 533 out of 720 (74%) patients. Most patients were unable to obtain follow-up mental and behavioral health care. Univariate regression analyses revealed that being White, having commercial insurance, or a positive suicide screen had higher odds of receiving intensive outpatient care. However, these variables were not statistically significant after multivariate analyses. Barriers to follow-up included long wait times and expense. Facilitators included support from ED staff and close relationships with primary care clinicians. 

Conclusions: We found potential socioeconomic disparities that influence mental health care follow-up. Our findings highlight challenges patients face to receiving outpatient care, serving as a valuable guide for improving the transition from the ED to outpatient settings.