Disparities in Pediatric Mental Health Care in Emergency Departments: A Scoping Review.

Abstract

Mental health disorders affect nearly 20% of adolescents across the United States, with notable racial and ethnic inequities in the provision, access, and outcomes for care. To understand the breadth of existing literature on racial and ethnic inequities and disparities in pediatric mental health care in emergency departments (EDs). PubMed, Science Direct, ProQuest, SCOPUS, Cochrane CENTRAL, hand search, and gray literature. 2 reviewers screened titles, abstracts, and full text. A third resolved disagreements. Studies were included if published between 2002 and 2024, included care for pediatric mental health in EDs, and provided information on outcomes by race and ethnicity. Extracted variables included publication year, author, objectives, setting, data source, study type, sample size, child age range, approach/methods, diagnosis, and findings. 50 articles of 2121 screened met inclusion criteria. These were categorized into the following groups related to disparities/inequities in ED mental health visits (n = 14), ED disposition (n = 7), outpatient and follow-up care (n = 3), diagnosis (n = 3), ED referral and prehospitalization care (n = 6), length of stay and boarding (n = 7), anxiety care (n = 1), suicidal ideation/self-harm care (n = 4), and restraint use in EDs (n = 7), with 2 articles in multiple sections. A total 43 articles (86%) found that racially marginalized patients experience unequal treatment in EDs compared to their non-Hispanic white counterparts. We cannot be certain that all pertinent literature was identified. Generalizability is limited due to geographic variability. Racially marginalized youth commonly receive unequal mental health care in EDs. Addressing these disparities will require evidence-based interventions and policies that confront systemic racism, implicit bias, and barriers to mental health access.