To describe trends in utilization of pediatric emergency department (PED) resources by patients with mental health concerns over the past 10 years at a tertiary care hospital.

We conducted a retrospective cohort study of tertiary PED visits from 2003 to 2012. All visits with chief complaint or discharge diagnosis related to mental health were included. Variables analyzed included number and acuity of mental health-related visits, length of stay, waiting time, admission rate, and return visits, relative to all PED visits. Descriptive statistics were used to summarize the results.

We observed a 47% increase in the number of mental health presentations compared with a 9% increase in the number of total visits to the PED over the study period. Return visits represented a significant proportion of all mental health-related visits (31%-37% yearly). The proportion of mental health visits triaged to a high acuity level has decreased whereas the proportion of visits triaged to the mid-acuity level has increased. Length of stay for psychiatric patients was significantly longer than for visits to the PED in general. We also observed a 23% increase in the number of mental health-related visits resulting in admission.

Mental health-related visits represent a significant and growing burden for the emergency department at a tertiary care PED. These results highlight the need to reassess the allocation of health resources to optimize acute management, risk assessment, and linkage to mental health services upon disposition from the PED.