Increase in Emergency Holds for Youth in Mental Health Crises Examined in New Study

Emergency holds allow authorities to transport minors to hospitals for evaluation without consent if there are immediate safety concerns. However, there has been limited pediatric research on the frequency of these holds and their impact on young patients' experiences in emergency settings.

The study reviewed 14,883 mental and behavioral health visits to a pediatric emergency department from January 2019 to December 2024. It found that the use of emergency holds increased annually, correlating with longer stays in the emergency department and a higher incidence of physical restraints.

Out of the visits analyzed, 2,219 (15%) involved a young person under an emergency hold. Among these cases, 64% were transported by law enforcement, 20% by a mobile crisis unit, and over 350 involved children aged 6 to 11. The study indicated that emergency hold status was linked to various factors, including race, sex, previous mental health emergencies, and longer emergency department stays. The population studied was predominantly Black and publicly insured, reflecting the demographics of the community served by the hospital.

Over the six-year period, there was a notable increase in physical restraint usage, which was related to arrivals under emergency holds. Notably, emergency holds did not show a correlation with mobile crisis involvement.

Christopher Gable, DO, an emergency medicine physician at Children’s National and corresponding author of the study, emphasized the need for careful consideration regarding emergency hold decisions for youth, as their implementation increased each year.

The findings underscore significant questions surrounding equity, crisis response, and restraint use in emergency care. They highlight the necessity to comprehend how prehospital decisions impact the care provided after arrival at the hospital.

While the study's focus was on a single emergency department, its results may not represent all hospitals or communities. Additionally, the findings suggest associations without proving direct causation, leaving open the question of whether emergency holds specifically contributed to restraint use or if other crisis factors were involved.

This research serves as a foundation for future efforts to enhance community responses for children and teens requiring urgent mental health care. Investigating the effectiveness of mobile crisis programs, specialized transportation, and earlier outpatient support could ensure safer pathways to care, reducing the need for detention and restraints.

The ultimate objective aims not just to limit interventions but to create a crisis system that prioritizes safety, dignity, and timely access to appropriate care for children. Further evaluation of strategies that lessen the use of restrictive measures and improve the integration of community and hospital services is necessary to deliver compassionate, equitable, and developmentally appropriate care.