Mental Health Emergencies - Waits for Care Grow Dramatically for Patients
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.
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.
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
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.
than half (57 percent) reported increased wait times and boarding for children
with psychiatric illnesses.
16.9 percent reported having a psychiatrist on call to respond to psychiatric
emergencies in the emergency department.
than 11 percent reported having no one on call to respond to psychiatric
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.”
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.
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”).
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
percent of psychiatric patients versus 13.5 percent of medical patients required
admission to the hospital.
percent of psychiatric patients versus 1.4 percent of medical patients were
transferred to another facility.
percent of psychiatric patients versus 10 percent of medical patients stayed in
the emergency department more than 6 hours.
percent of psychiatric versus 2.3 percent of medical patients stayed in the
emergency department for more than 12 hours.
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.”
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.
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 90th
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 90th
percentile length of stay.”
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.