It would seem logical that giving people access to primary health-care services would help cut down on visits to the emergency room. But a new study suggests that when it comes to mental-health services for kids, that may not be the case. Researchers at Johns Hopkins Children’s Center looked at patient records for kids aged 3 to 17 who made visits to the hospital’s ER for mental-health issues. The majority of these visits were for relatively minor problems such as disruptive behavior at school, fighting with siblings or running away, Emily Frosch, lead author of the study and a pediatric psychiatrist at Hopkins Children’s, tells the Health Blog. Of 2,903 patients who initially visited the ER for mental-health reasons, 338 returned within six months. That, despite the fact that 71% of those repeat visitors initially reported having a current outpatient mental-health provider — 85% on the second visit. Frosch says that there’s been a big focus on improving access to community-based mental-health care as a way of cutting down on ER use. But that strategy may not account for the needs of providers or of patients. For example,

it’s possible mental-health providers are telling their patients to go to the ER for after-hours problems. Or maybe parents “feel if they show up in the ER, they get a faster response,” she says. “We need to better understand how the ER is meeting their needs,” says Frosch. The connection to outpatient care was self-reported, and didn’t include information on how frequently or recently the child saw a provider. It’s also not clear whether these results are generalizable to other areas or populations. The 338 return visitors were mostly male (56%) and African-American (80%).  Almost all (82%) were receiving Medicaid assistance. Nor is it clear whether similar trends would hold in other aspects of medicine. But a recent poll conducted by the American College of Emergency Physicians found that 97% of the 1,768 ER docs who responded reported treating patients daily who were referred by a primary-care provider. The study was published by the journal Psychiatric Services. Bonus: Dartmouth Atlas Project Says Access to Primary Care No Guarantee of Better Care Image: iStockphoto

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Access to Mental-Health Care No Guarantee Kids Won’t Visit the E.R.