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Emergency Room Visits for Mental Health Conditions: Expect Long Waits

     

An estimated one in eight emergency room visits involves a mental health and/or substance use condition, according to the Agency for Healthcare Research and Quality. All too often when people go to emergency rooms with psychiatric conditions they end up waiting much longer than people with other health concerns. And if they need inpatient treatment, they may end up waiting for days.

Boarding psychiatric patients in an emergency department is both poor medicine and expensive.”

Scott Zeller, M.D.

Mood disorders are the most common mental health reason for ER visits, accounting for more than 40 percent, followed by anxiety disorders and alcohol-related conditions.

Researchers from the University of Pennsylvania found people needing mental health care wait on average almost two hours longer in the ER than people needing general medical care. They examined data on more the 200,000 ER visits over nearly a decade and found that more than twice as many psychiatric patients as general medical patients waited in the ER for more than 6 hours.

Compared to patients with other medical concerns:

  • Psychiatric patients admitted for observation waited an average of more than an hour longer
  • Psychiatric patients who were transferred waited an average of nearly three hours longer
  • Psychiatric patients who were discharged from the ER waited an average of just over an hour longer

A recent poll from the American College of Emergency Physicians found more than one in five emergency physicians said they have patients waiting two or more days for in-patient psychiatric beds. Almost half of the emergency physicians reported psychiatric patients are held (or "boarded") in their emergency department waiting for an in-patient bed one or more times a day.

Several factors may be contributing to the lengthy waits. Many emergency rooms are not equipped to handle people with serious mental health issues. They do not have psychiatrists or other mental health clinicians on staff to assess and treat mental health problems. In the ACEP poll, only 17 percent reported having a psychiatrist on call to respond to psychiatric emergencies. The number of psychiatric visits has increased at a much faster pace than general medical visits.

Another contributing factor is the shortage of psychiatric beds. The number of psychiatric hospital beds in the U.S. has dropped significantly in the past several decades — more than 96 percent since the 1950s and more than 17 percent just since 2010, according to a 2016 report from the Treatment Advocacy Center.

Scott Zeller, M.D., chief of psychiatric emergency services at Alameda Health Systems in Oakland, Calif told APA’s Psychiatric News, “Boarding psychiatric patients in an emergency department is both poor medicine and expensive.” He noted that the average cost per patient is more than $2,000 (in addition to general medical care).

Some health systems are taking action to address this problem. For example, Alameda Health Systems has established a specialized psychiatric emergency department that sees 1,500 or more patients per month. It is staffed by doctors and nurses, but also uses groups and occupational therapy. They use a collaborative approach to address patients’ needs. They’ve seen positive results — boarding times have been reduced to an average of two hours and about 75 percent are successfully discharged.

With this approach, Zeller noted, “We still need hospitals and inpatient beds, but we are able to give better care, save money and increase access.”

References and Resources

     

AnxietyDissociative DisordersADHDBipolar DisordersIntellectual DisabilitySleep DisordersDepressionPatients and FamiliesHoarding DisorderAlzheimer’sOCDPersonality DisordersEating DisordersGambling DisorderSpecific Learning DisorderSomatic Symptom DisorderSchizophreniaAddictionPTSD

 

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