ER Visits for Kids: Not a Good Way to Address Mental Health Crises

Tuesday January 3, 2022

A new study links state abortion restrictions to higher suicide rates among women, and another points to the futility of using psychiatric ERs to address kids’ mental health crises. Hawaii creates a new Office of Resiliency and Well-Being to address trauma. And take a tour of the mental health issues that power up (and sometimes hold back) Marvel’s superheroes.

---

If you’re thinking about suicide, this list might save your life

A novel way to prevent suicides is gaining a little traction: voluntary don’t-sell-me-a-gun laws are gaining support in state legislatures. The laws let people concerned that they might self-harm to place themselves on a confidential list, part of each state’s background check system. Gun shops must consult these lists before completing a sale. People can change their mind after signing up, but they must wait 21 days.

Three states ─ blue Washington, purplish Virginia and red Utah ─ have enacted such laws, and bills have been introduced in at least nine others, the good-news site Reasons to be Cheerful reported. A national version introduced in Congress in July was sponsored by a Washington Democrat and a Utah Republican and called a “libertarian approach” in a Wall Street Journal essay. It will need to be reintroduced in the new Congress.

While some people argue that people won’t sign up, advocates point to signs that they will. A New England Journal of Medicine perspective piece compared placing oneself on a voluntary do-not-sell list ─ perhaps at the recommendation of a mental health provider or primary care physician ─ to executing an advanced directive for medical decisions, and cited surveys showing substantial support for the idea. Fred Vars, a law professor who has bipolar disorder and has experienced suicidal ideation, asked 200 psychiatric patients at the University of Alabama Medical Center if they would sign up and nearly half said yes. “So much about suicide is impulsive,” he said. “I don’t want to die, and me signing up for this list would reduce the probability of me dying.”

---

“I edited mental illness out of my college applications. I’m not alone.”

In a guest essay for the New York Times, Emi Nietfeld remembers agonizing more than a decade ago about whether to disclose her mental health struggles in an application essay that would make her stand out ─ or play it safe. She took the former route in an early application to Yale and was rejected. She tried the safe approach with Harvard and got in. That, college admissions officers told her in recent interviews, is still the best way to go.

---

Some upbeat stories to start 2022:

A restaurant transitions: Award-winning Wisconsin chef Dave Heide closed his long-running Liliana’s Restaurant south of Madison in September ─ and reopened it in November as Ollie’s, in honor of his recently transitioned son, LGBTQ Nation reported. “My kiddo doesn’t go by the name that’s on the restaurant anymore,” Heide told the Wisconsin State Journal when he announced his plans last spring. “I love you Ollie, no matter your name, your gender, or your pronouns,” he wrote on Facebook. “You will always be my kiddo that I am proud of and love.”

---

Superheroes in Marvel comics and movies grapple with a wide range of mental health issues from depression to PTSD to borderline personality disorder. These conditions often drive them to excess and force them to find some pretty weird coping strategies. But the fact the Marvel develops such characters as heroes may in itself help the global battle against an enemy: stigma! MovieWeb has a rundown.

Kids cycle in and out of psych ERs, as parents seek ways to stem their aggression

As we’ve heard many times before, children’s emergency room visits have increased sharply in recent years, along with rates of depression and suicide attempts. Now a large new study in JAMA Pediatrics offers some new insights to that trend. It found that while visits to pediatric ERs increased 1.5% a year from 2015 to 2021, visits for mental health crises jumped 8% a year. What’s more, 13% of those young patients returned within six months.

The adolescents most likely to come back were not patients who harmed themselves, the New York Times reported. Instead they were kids whose agitation and aggressive behavior were too much for their parents and caregivers to handle. Many had previously received sedatives or other drugs to restrain them when their behavior became disruptive. The data point to the futility of trying to handle mental health problems at an ER, clinicians say.

“It’s just putting a Band-Aid on the problem,” Christine M. Crawford, a child and adolescent psychiatrist at Boston Medical Center, told the Times. “They go back home and they’re still waiting for that appointment to meet with a therapist.”

The researchers analyzed more than 308,000 mental health visits at 38 hospitals and found that youth with psychotic disorders were 42 percent more likely to revisit the emergency department within six months, compared to those with suicidal or self-harming behavior. Patients with impulse control disorders were 36 percent more likely to come back, and patients with disorders like autism and ADHD and those who required medications to subdue them were each 22 percent more likely to revisit.

The results suggest that researchers should focus more attention on children with cognitive and behavioral problems, and whose parents may turn to emergency rooms for respite, study co-author Anna M. Cushing, a pediatric emergency room physician at Children’s Hospital Los Angeles, told the Times. They “really just are at their wit’s end,” she said. “Their child’s behavior may be a danger to themselves, but also to the parents, to the other children in the home.”

---

Abortion restrictions linked to higher suicide rates

Restricted access to abortions was associated with a heightened risk of suicide among women ages 20 to 34, according to a four-decade-long study covered by NBC News. The study, in JAMA Psychiatry, examined suicide rates in states that enforced restrictive laws requiring abortion providers to be located near a hospital, increasing travel time for many women. Such laws were enforced in 21 states between 1974 and 2016 and the researchers found an average 5.8% higher risk of suicide among women of prime childbearing age after enforcement began in those states. There was no change among older women.

The study could not show cause and effect, but the researchers at University of Pennsylvania and Children’s Hospital of Philadelphia theorized the laws could amplify stress and anxiety among women of reproductive age. “Stress is a key contributor to mental health burden and a major driver of increased suicide risk,” co-author Ran Barzilay said in a press release. The findings add to earlier research that found increased short-term anxiety and loss of self-esteem among women who had been denied abortions.

Roe v Wade, in effect during the study period, constrained states somewhat in restricting abortion access. Following the Supreme Court’s Dobbs decision last summer, laws banning nearly all abortions are in effect in 12 states, according to the Guttmacher Institute, with other state bans held up in court.

---

New Hawaii agency will address trauma

Hawaii Gov. Josh Green named a mental health veteran to head a first-of-its-kind agency focused on helping people deal with childhood trauma and other mental health issues, Hawaii News Now reported. The Governor’s Office of Wellness and Resilience was created by a new law that budgeted almost $900,000 to start the agency, which must seek federal funding and rely, for now, on staff borrowed from other departments.

Tia Roberts Hartsock, who currently helps young female trauma survivors in the criminal justice and child welfare system, will direct the office, which is charged with developing concrete plans to improve the physical and emotional well-being of people in Hawaii.

 “The suffering many of us struggle with, including historical and cultural traumas, has very real effects on our health status individually and as a whole,” Hartsock said at a July press conference shortly after the bill was signed into law. “We are striving to map out ways we can connect our state’s workforce and the families we serve to practices that promote wellness and build resilience,” she said.

---

In other news…

Organization tending to unhoused people in North Texas are increasingly providing mental health services, along with offering food and operating warming centers, according to Dallas-based KERA News. “Everyone at Austin Street Center is grieving the loss of something,” one official said. “The loss of a job, the loss of a home, the loss of a loved one. Then they are unfortunately just unable to cope.”

More than 30 states have joined the Psychology Interjurisdictional Compact, which permits psychologists to offer remote mental health services outside the state in which they are licensed. Michigan became the latest state to sign on to the compact, Michigan Live reported.

---

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

---