• Jeffrey A Bridge, Steven C Marcus, and Mark Olfson.
• Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, The Ohio State University, USA.
• J Am Acad Child Adolesc Psychiatry. 2012 Feb 1;51(2):213-222.e1.

ObjectiveLittle is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm.MethodA retrospective longitudinal cohort analysis was conducted of national 2006 Medicaid claims data supplemented with the Area Resource File and a Substance Abuse and Mental Health Services Administration Medicaid policy survey of state policy characteristics focusing on ED treatment episodes by youth 10 to 19 years old for deliberate self-harm (n = 3,241). Rates and adjusted risk ratios (ARR) of discharge to the community, mental health assessments in the ED, and outpatient visits during the 30 days after the ED visit were assessed.ResultsMost patients (72.9%) were discharged to the community. Discharge was inversely related to recent psychiatric hospitalization (ARR 0.75, 99% confidence interval [CI] 0.63-0.90). Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. Follow-up mental health care was directly related to recent outpatient (ARR 2.58, 99% CI 2.27-2.94) and inpatient (ARR 1.33, 99% CI 1.14-1.56) mental health care and inversely related to Hispanic ethnicity (ARR 0.78, 99% CI 0.64-0.95) and residence in a county with medium-to-high poverty rates (ARR 0.84, 99% CI 0.73-0.97).ConclusionsA substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care.

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