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Rady Children’s finds success in reducing mental health visits to emergency department


The pediatric health system based in San Diego has placed mental health professionals in primary care practices, and it appears to be making a difference.

Like many pediatric health systems, Rady Children’s Hospital has seen a surge of children coming into the emergency department with behavioral health needs.

Image: Rady Children's Hospital

Benjamin Maxwell of Rady Children's Hospital says placing mental health professionals with primary care providers is helping patients get help earlier.

Benjamin Maxwell, MD, division chief of child and adolescent psychiatry and chair in behavioral health at Rady Children's, told Chief Healthcare Executive® in December 2022 that the uptick in pediatric mental health emergencies “is beyond unprecedented for us.”

But Rady Children’s is seeing some success in reducing the number of children and teens coming to the emergency department for mental health needs. The San Diego health system has been placing mental health professionals in primary care practices, and the initiative seems to be making a difference.

To date, Rady Children’s has seen a 40% reduction in mental health visits to the emergency department. The system has also reported a 44% decline in anxiety symptoms and a 62% drop in depression symptoms. The findings were published by Frontiers in Psychiatry in November 2023.

Rady Children’s says in many cases, kids in primary care practices can see a mental health professional that day.

“With the integrated care model, the pediatrician can literally walk down the hall and introduce the family to the therapist right there in the office,” Maxwell said in a statement. “Families are already coming to a place that they trust, which enhances continuity of care and ultimately better outcomes.”

The program enables young people to have easier access to mental health treatment and reduces the chance the situation will escalate to an emergency.

There are 11 primary care practices and four regional support hubs involved in the program, with the hopes of detecting challenges and intervening earlier to help kids.

“The difficult truth is that children and adolescents often do not receive mental health care when they need it,” Domonique Hensler, senior director of systemwide Care at Rady Children’s, and a co-author of the study, said in a statement.

“The need for effective, accessible treatment is more pressing than ever,” Hensler said. “Our interdisciplinary, team-based approach to pediatric mental health care has been shown to be efficacious, accessible, and cost-effective.”

Primary care physicians have been offered a three-day training program to assess and treat some mental health conditions. So far, more than 200 providers have gone through the training, and they’re making an estimated 100 referrals each week.

Adam Breslow, MD, president and CEO of Children’s Primary Care Medical Group, said earlier intervention is critical to help children and teens before their mental health needs become more serious.

“In our collaborative model, families are introduced to a mental health professional by someone they know and trust,” Breslow said in a statement. “The process is well accepted by patients and families.”

Pediatric health systems across the nation are seeing greater demands of their services for mental health needs.

Lawrence Moss, president and CEO of Nemours Children’s Health, says the system has seen an increase in adolescents needing treatment at the system’s children's hospitals for mental health issues.

“People often say, ‘COVID caused the child mental health crisis.’ Not true,” Moss told Chief Healthcare Executive® in an interview last November. “There was a child health mental health crisis before COVID. We just weren't talking about it enough and realizing it, and COVID shined a bright light on it and made it worse.”

The Children’s Hospital Association released a survey last December that found almost all pediatric hospitals (94%) said they have seen an increase in the number of children and teens requiring mental health services. More than half of children’s hospitals (58%) surveyed said they are concerned about a lack of mental health resources to care for those patients.

The number of young people visiting emergency departments for mental health reasons rose from 4.8 million in 2011 to 7.5 million in 2020, according to a study published by the Journal of the American Medical Association.

Dozens of healthcare organizations have described the pediatric mental health crisis as a national emergency.

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