Trends in Emergency Department, Primary Care, and Behavioral Health Use for Pediatric Mental Health Conditions in Virginia before and during the COVID-19 pandemic.

Abstract

Pediatric emergency department (ED) visits for mental health are costly and often preventable. Access to primary care and behavioral health providers can improve mental health and reduce unnecessary ED visits. Quantitative analysis of the Virginia All-Payers Claims Database to assess mental health ED and outpatient care for children and adolescents up to age 21 years between 2016 and 2021. We determined the proportion of children and adolescents seen by primary care or behavioral health one week and one year before an ED visit, and how many had follow-up care within one and two months after. From 2016 to 2021, pediatric ED visits dropped 14%, but mental health visits rose 10.6%, and suicidality visits tripled (301 to 929, p < 0.001). Only 5% of youth with suicidality ED visits had a primary care visit within 7 days prior, and 18% saw a mental health provider. During the pandemic, prior-year primary care visits for mental health ED cases declined (68.1-61.8%, p < 0.0001). Follow-ups within 60 days dropped for primary care (mental health: 40.0-34.2%; suicidality: 37.5-33.5%), slightly improved for behavioral health (32.2-37.1%), and stayed stable for suicidality (64.1-63.0%). The pediatric mental health crisis has worsened since the pandemic. There were substantial missed opportunities for prevention and intervention for children and adolescents prior to and following an ED visit for mental health or suicidality.