Centra responds to rise in behavioral health visits in emergency room (2024)

As the state of Virginia experiences a rise in pediatric emergency room visits for behavioral health issues, Centra Health is taking proactive steps to ensure optimal care for children, particularly those with autism. The health care system has initiated training programs for ER caregivers to support, communicate and assist patients with autism more effectively.

Dr. Jitendra Annapareddy, child psychiatrist and medical director for autism services at Centra, said pediatric mental health has always been underfunded.

“Before the pandemic, it was managed reasonably well, but since then, there has been a significant increase in mental health challenges among children, especially adolescents,” he said.

According to Annapareddy, the pandemic exacerbated existing issues, resulting in a 20% to 30% increase in diagnosable mental illnesses among the pediatric population. The mental health system, already stretched thin, struggled to accommodate this surge, leading many families to seek help in emergency rooms.

“The ER often becomes the primary care point when the system’s capacity is overwhelmed,” Annapareddy said.

He said the pandemic-induced isolation and lack of social interaction significantly increased suicidality and aggressive behaviors among children, further driving up ER visits.

In contrast to the rising trend statewide, Centra has observed a steadiness in its numbers, thanks in part to their robust behavioral health services. This stability is attributed to Centra’s comprehensive approach, which includes collaboration with Horizon Behavioral Health, among other partners.

Centra’s response involves education and support for health care providers. By training ER caregivers on how to interact with patients with autism, Centra hopes to reduce the distress these children may experience during visits. The goal is to provide appropriate care and minimize the need for emergency interventions.

“Education helps providers understand why these patients present to the ER and how to manage their challenges effectively,” Annapareddy said. “By increasing awareness and confidence among caregivers, we hope to reduce future ER visits and ensure children receive the right care at the right time.”

Crystal Collette, senior director of psychiatry and behavioral health who oversees the operations of the Autism Clinic, said the hospital recognizes that this has a big impact on the families that are coming in waiting and desperate for those services.

“So, we are really trying to be strategic about the future programs that we offer from an outpatient perspective,” she said. “And of course, the new behavioral health hospital is in the works as well.”

From an outpatient perspective, staff is looking at expanding offerings for the child and adolescent population.

“And part of my role is to see how we can attract even more providers here to serve this population and really tailor the needs to what the community needs, which is more services,” she said.

Megan Hamlett, unit manager of Lynchburg General Hospital’s ER, said there are unique challenges faced by patients with autism in the emergency setting.

“We’ve definitely noticed an increase in our autistic patient population visiting the department. While most are adolescents, we do see some adults as well,” Hamlett said. “The ER is a very busy, loud, and hectic environment, which is not ideal for these patients due to their sensory sensitivities.”

Hamlett’s team has reached out to Centra’s autism services team for guidance.

“We started an education series where the autism team is offering training to our [emergency department] staff. This training is recorded for broader access and includes suggestions on making our environment more sensory-friendly,” she said.

The autism team has toured the department to provide practical recommendations, such as using visual cues to structure the patients’ time and creating a more welcoming atmosphere in the behavioral health area.

The rise in behavioral health visits is not limited to autistic patients. Hamlett said that there has been an overall increase in pediatric behavioral health cases.

“There are days when we have more pediatric behavioral health patients than adults,” she said. “We often face extended waits for placement in appropriate facilities, with patients sometimes staying with us for days or even weeks. This lack of immediate placement is a major concern.”

The extended stays can cause additional stress for autistic patients.

“Children, especially those with autism, need routine and understanding. When that is disrupted, it can lead to escalation. We are working hard to figure out how to help them during these extended stays,” Hamlett said. “Communication is key, but it’s challenging when patients have difficulty understanding what is happening.”

To address these issues, Centra is enhancing collaboration between the ER and behavioral health specialists.

“I think just having that collaboration is huge. From our ED side, we are going to try to make our behavioral health area a little more friendly and make that more welcoming and more inviting and a little more therapeutic than it currently is,” she said. “Having this open line of communication will help these patients and their families.”