Ignoring Kids’ Mental Health Needs is Expensive

With most of the Affordable Care act being upheld this week by the Supreme Court, it seems like an apt time to review an example of how costs rise when kids’ mental health needs are not sufficiently addressed.

A few months ago The American Journal of Child and Adolescent Psychiatry published a national study regarding the cost of pediatric (age ≤ 18) usage of emergency room visits in the U.S. from 2001 to 2008. (As many know, ER and hospital care is usually much more expensive than outpatient care. Moreover, mental health problems are more likely to be treated in this more expensive setting when a youth’s outpatient needs for care have not been adequately attended to.) The abstract can be found here. Some high points:

• Of the 73,105 visits, 1,476 were for mental health issues. When appropriate statistical adjustments were made, it was estimated that there are 480,700 emergency department visits for mental health issues in the US each year.

• 21.8% of the mental health contacts arrived by ambulance compared to 6.3% of other kinds of contacts; they also stayed longer (median 169 minutes vs. 108 minutes) and had a higher rate of admission into the hospital (16.4% vs. 7.6%).

• The rate of usage was not significantly different across gender and between Caucasian and African-American kids; however, the usage rates for Hispanics was lower than non-Hispanics.

• Quoting the authors: “Depressive disorders were the most common principal diagnoses, followed by anxiety and disruptive behavioral disorders or ADHD.”

• Following appropriate statistical adjustments, the researchers determined that 1/3^rd of the mental health related visits to hospitals result in a hospitalization.

• Additional collateral costs (e.g., the need to have security personnel monitor the youth, the fact that many arrived with escorts that had a professional role in the child’s life) were also noted.

• Quoting the authors: “Probability of extended stays for mental health visits rose over the period that we studied. By 2008, the odds of an extended stay (> 4 hours) was almost twice that in 2001, and we did not observe comparable growth in the duration of non-mental health visits.”

The authors also acknowledge that their rates may represent underestimates of usage as they used stricter criteria for defining a mental health visit than have other investigators that have examined this area.

For me this study place another brick in the wall that demonstrates the tremendous costs–financial only being one of them–that accrue when we neglect the mental health needs of our children and teenagers. If you’d like to read more about this, please see Chapter 10 of my book Working Parents, Thriving Families, or any of the blog entries below: