Pediatric Mental Health Boarding

Abstract

CONTEXT: The growing prevalence of pediatric mental and behavioral health disorders, coupled with scarce psychiatric resources, has resulted in a substantial increase in the number of youth waiting in emergency departments (EDs) and medical units for inpatient psychiatric care. OBJECTIVE: To characterize the prevalence of pediatric mental health boarding and identify associated patient and hospital factors. DATA SOURCES: Medline and PsycINFO. STUDY SELECTION: All studies describing frequencies, durations, processes, outcomes, and/or risk factors associated with pediatric mental health boarding in youth #21 years of age. DATA EXTRACTION: Publications meeting inclusion criteria were charted by 2 authors and critically appraised for quality. RESULTS: Eleven studies met inclusion criteria; 10 were retrospective cohort studies and 9 were conducted at single centers. All of the single-center studies were conducted at children's hospitals or pediatric EDs in urban or suburban settings. Study sample sizes ranged from 27 to 44 328. Among youth requiring inpatient psychiatric care, 23% to 58% experienced boarding and 26% to 49% boarded on inpatient medical units. Average boarding durations ranged from 5 to 41 hours in EDs and 2 to 3 days in inpatient units. Risk factors included younger age, suicidal or homicidal ideation, and presentation to a hospital during nonsummer months. Care processes and outcomes were infrequently described. When reported, provision of psychosocial services varied widely. LIMITATIONS: Boarding definitions were heterogeneous, study sample sizes were small, and rural regions and general hospitals were underrepresented. CONCLUSIONS: Pediatric mental health boarding is prevalent and understudied. Additional research representing diverse hospital types and geographic regions is needed to inform clinical interventions and health care policy.

Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children’s Hospitals

“…Children who require inpatient mental health treatment are often admitted to the medical unit until a psychiatric inpatient bed becomes available, referred to as mental health boarding. 33 Mental health boarding may result in delays obtaining access to psychiatric inpatient services and lead to long inpatient stays with high encounter costs. 34 Another contributing factor may be the shortage of child psychiatrists in both outpatient facilities and hospitals in several US regions, 35,36 with declining ratios of child psychiatrists to children over time.…”

COVID-19 Management in Pediatrics

“…The US has observed significantly greater ratios of hospitalizations and deaths from COVID-19 in diverse racial and ethnic populations than non-Hispanic Whites 46 . Native Americans, African Americans, and Hispanics had hospitalization rates approximately five times that of non-Hispanic Whites 42 . Likewise, the pandemic has negatively affected the mental health of these diverse groups as businesses closed, social relationships changed, and jobs were lost 47 .…”

“…The growing prevalence of pediatric mental and behavioral health disorders coupled with scarce psychiatric resources have resulted in a substantial increase in the number of youths waiting in emergency departments and medical units for in-patient psychiatric care; 42 this has been exacerbated from the effects of lockdown and social distancing. As children and adolescents depend on friendships to maintain self-worth, manage anxiety and depression, the pandemic lockdown has increased feelings of isolation and depression among them despite their being adept at using social media platforms and gaming technology.…”

“…Following recovery, the provider needs to assess the patient’s infectivity as reinfection and reactivation may occur. Ye et al found five patients with previous COVID-19 infection presented with reactivation weeks later 42 . Post-infection immunity is an active topic that is fascinating the public and has boosted antibody testing, however, the clinical significance of the antibody response remains unclear.…”

A Call to Action to Address Disparities in Pediatric Mental Health Care

“…In this issue of Pediatrics, McEnany et al 1 performed a meta-analysis to better understand pediatric mental health boarding in emergency departments and patient and hospital characteristics that increase the likelihood of boarding. Visits to pediatric emergency departments for mental health-related complaints have steadily increased over the past decade, 2,3 resulting in significant delays in care for patients, increased resource use in emergency departments, and significant inpatient costs.…”