Mental Health Emergencies - Waits for Care Grow Dramatically for Patients

The nation’s dwindling mental health resources are contributing significantly to increased wait times and longer emergency department stays for patients having psychiatric emergencies, including children. Three-quarters of emergency physicians responding to a poll report seeing patients at least once a shift who require hospitalization for psychiatric treatment; almost one-quarter (21 percent) say they have patients waiting two to five days for in-patient beds., according to the results of a poll of more than 1,700 emergency physicians along with research.

“More than half (52 percent) of emergency physicians say the mental health system in their communities has gotten worse in just the last year, and the consequences of that play out in our emergency departments,” said Rebecca Parker, MD, FACEP, of the American College of Emergency Physicians.

“Psychiatric patients wait in the emergency department for hours and even days for a bed, which delays the psychiatric care they so desperately need. It also leads to delays in care and diminished resources for other emergency patients. The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system.”

Other findings include:

• Almost half (48 percent) of respondents reported psychiatric patients are held (or “boarded”) in their emergency department waiting for an in-patient bed one or more times a day.
• More than half (57 percent) reported increased wait times and boarding for children with psychiatric illnesses.
• Only 16.9 percent reported having a psychiatrist on call to respond to psychiatric emergencies in the emergency department.
• More than 11 percent reported having no one on call to respond to psychiatric emergencies.
• More than 10 percent reported having 6 to 10 patients waiting for inpatient psychiatric beds on their last shift.

“Virtually every emergency physician I know can report anecdotally about the surge in psychiatric patients filling their emergency departments waiting for care in the last year,” said Dr. Parker.  “It is an outrage. These patients have needs that are simply not being met. The severe shortage of psychiatric beds in almost all hospitals and intensive outpatient resources is leaving these patients stranded for hours and even days.”

Two studies detail the deteriorating network of support for patients with mental illness and the growing disparity in wait times from 2002 to 2011 between patients with psychiatric emergencies and patients with medical emergencies.

Patients with bipolar disorder, psychosis, dual diagnosis, multiple psychiatric diagnoses and depression had increased odds of being in the emergency department for more than 24 hours, according to a study (“Mental Health Emergency Department Visits: 24 Hours and Counting, Characteristics Associated with Prolonged Length of Stay”).

A related study (“Waiting for Care: Differences in Emergency Department Length of Stay and Disposition Between Medical and Psychiatric Patients”) finds enormous differences in disposition between psychiatric and medical patients in the emergency department:

• Twenty-one percent of psychiatric patients versus 13.5 percent of medical patients required admission to the hospital.
• Eleven percent of psychiatric patients versus 1.4 percent of medical patients were transferred to another facility.
• Twenty-three percent of psychiatric patients versus 10 percent of medical patients stayed in the emergency department more than 6 hours.
• Seven percent of psychiatric versus 2.3 percent of medical patients stayed in the emergency department for more than 12 hours.

“Overall, psychiatric patients waited in the emergency department significantly longer than medical patients did,” said lead study author of both papers, Suzanne Catherine Lippert, MD, MS, FACEP of Stanford University, Stanford, Calif. “In a time of decreased psychiatric in-patient beds and variable access to outpatient psychiatric centers, we are looking at a potential crisis of unmet psychiatric need.  Clinical outcomes for psychiatric patients subjected to prolonged emergency department lengths of stay must be examined alongside the impact of these stays on emergency department crowding.”

Dr. Renee Hsia, who has also studied the issue and recently published her findings in Health Affairs, noted that psychiatric emergency patients consistently waited longer in emergency departments than non-psychiatric patients.

“The absolute number of psychiatric visits increased by 55 percent, from 4.4 million to 6.8 million between 2002 and 2011, far outpacing the growth of non-psychiatric visits,” said Dr. Hsia. “The disparities between psychiatric and non-psychiatric patients are very stark: in 2011, the 90^th percentile length of stay was 1,378 minutes for psychiatric patients, and 543 min for non-psychiatric patients, which amounts to a difference of almost 14 hours! This is especially disturbing when you recognize that in 2002, psychiatric and non-psychiatric patients had virtually the same 90^th percentile length of stay.”

Poll Methodology: 

This survey was conducted online between September 28 and October 6, 2016 with 1,716 emergency physicians. There was a response rate of 6.4 percent and a margin of error of ± 2.3 percent. For complete poll results, please click here.