Emergency department care experiences among youth with mental health concerns

TL;DR

Youth with mental health concerns report negative experiences in emergency departments compared to their peers, highlighting the need for improved care.

Contribution

This study identifies specific disparities in emergency department care experiences among youth with mental health concerns.

Findings

Youth with mental health concerns reported greater negative effects of identity on ED experiences compared to controls.

They experienced higher levels of disrespect and negative feelings during ED visits.

Qualitative themes revealed stigmatization, unmet care needs, and lack of mental health expertise in EDs.

Abstract

Emergency departments (EDs) are important for mental health (MH) care among youth, however, are often ill equipped to meet their needs, resulting in care dissatisfaction. The objective of this research is to better understand the ED care experiences among youth with MH concerns. Data was used from a cross-sectional, mixed-methods study comparing ED care experiences among individuals who identify as equity-deserving with those who do not. Equity deserving groups are defined as individuals who face shared barriers to participating in society and care as a result of identifying with a certain community. For this sub-group analysis, participants who identified as youth aged 16–24 with a MH concern were compared to age-matched controls. Descriptive and inferential statistics, including chi squared tests were used to evaluate differences in sociodemographic and ED visit data between groups. Qualitative micronarratives were thematically analyzed to contextualize quantitative findings. A total of 81 youth with MH concerns and 108 youth controls were included in the analysis. Compared to controls, youth with MH concerns experienced greater: negative effects of their identity on ED experiences; disrespect in the ED; and negative feelings throughout their ED visit (p<0.001 for all). Themes identified in the qualitative analysis supported these findings including judgement and stigmatization, unmet care needs, lack of MH expertise and community connections, and negative impacts of the ED environment on MH experiences. This study adds to evidence demonstrating that youth with MH concerns have largely negative experiences with ED care in comparison to age-matched control group. Interventions to improve care could include improving MH expertise in the ED with existing or new staff and enhancing connections to community MH resources.

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