Chicago’s busiest emergency rooms are getting too many kids’ mental health crises wrong, and it is costing families time, safety, and peace of mind. That is the warning from a new analysis by Ann & Robert H. Lurie Children’s Hospital of Chicago, which found that the way emergency departments triage young patients with psychiatric complaints often fails to match the true level of risk. When the initial sort is off, some children are sent home when they should be watched more closely, while others wait for hours in crowded ERs as staff scrambles to find scarce psychiatric beds.
Local clinicians and researchers say the findings land in the middle of a youth mental health crunch, and they argue hospitals need to rethink how they spot, sort, and prioritize kids in behavioral health distress before more fall through the cracks.
What the Lurie analysis found
According to reporting from Crain's Chicago Business, the Lurie team’s review of emergency triage decisions showed that children and teens with mental health concerns are frequently assigned acuity levels that either underestimate or overestimate how urgently they need care. Those misfires can translate into unsafe discharges or into kids being funneled into high-resource pathways that may not actually match their needs.
The account credits the researchers with looking at how triage calls lined up with what happened next in the ED, including admissions, transfers, and length of stay. Their conclusion: current tools and on-the-fly clinical judgment are not reliably separating the highest risk youth from those who can safely wait or be treated in lower intensity settings.
Triage tools under the microscope
One problem, researchers say, is the bluntness of the tools that many ERs rely on. A study in the Journal of Emergency Nursing put two common approaches to the test: the Emergency Severity Index, or ESI, and the Australian Mental Health Triage Scale. Triage-trained nurses were asked to rate 30 hypothetical pediatric behavioral health cases. The Australian scale produced substantially better agreement between raters, with an intraclass correlation coefficient of 0.81 compared with 0.63 for ESI.
The authors point out that ESI tends to cram many psychiatric complaints into a narrow band of acuity. That clustering makes it harder to tell which kids truly need urgent inpatient care and which can be managed with less intensive support. The inconsistency, they suggest, helps explain why some high-risk children slip past triage without enough scrutiny, while others get routed into very resource-heavy responses they may not actually require.
Boarding, insurance, and inequity
The triage problem plays out against a national backdrop where children in crisis often have nowhere to go. A large analysis published in JACEP Open found that roughly one in three pediatric emergency visits for mental health that ended in admission or transfer involved waits longer than 12 hours for a psychiatric bed. More than one in eight kids waited over 24 hours.
The investigators and institutional reports also highlight who tends to wait the longest. Youth with public insurance were more likely to experience extended emergency department stays, a pattern researchers link to shortages of inpatient psychiatric beds and reimbursement gaps that make some hospitals reluctant to expand capacity.
In a statement to Lurie Children's Hospital, lead author Jennifer Hoffmann, MD, said, “Our study underscores significant issues with access to mental health care for children and adolescents.”
Chicago response and next steps
In Chicago, Lurie has tried to carve out at least a little breathing room. The hospital has opened a small inpatient psychiatric unit tailored for youth with autism and complex behavioral needs. The unit has four beds and about 20 staff members, according to the Chicago Sun-Times. It is hardly a solution to a citywide surge in pediatric mental health emergencies, but hospital leaders say it is one concrete step for a group of kids who often end up stuck in ERs for lack of better options.
Advocates and clinicians argue that the real fix has to be broader. They are calling for behavioral health-specific triage tools that can better sort risk in real time, more telepsychiatry support so community hospitals are not flying blind when a young person arrives in crisis, and stronger school and neighborhood-based mental health services so families are not forced to treat the emergency room as the only door into care.
Those local conversations echo a national alarm. Pediatric organizations, including the American Academy of Pediatrics and the Children’s Hospital Association, have declared a national emergency in children’s mental health and continue to push for large-scale investment in prevention, outpatient treatment, and crisis services.
Researchers and front-line clinicians say that if hospitals pilot more precise behavioral health triage instruments, train triage staff in psychiatric risk assessment, and expand community crisis resources, they could cut down on dangerous misclassification and reduce the long “boarding” stays that clog emergency departments. Better tools and more capacity, they argue, would make it more likely that kids in crisis get the right level of care at the right time, and that everyone else in the ER is not left waiting in the process.
