WBB's Thought Leadership

Study Shows Psychiatric Patients are Filling Emergency Rooms

November 15

A rapidly growing number of patients with psychiatric disorders are resorting to using emergency rooms in the absence of managed mental health care and treatment.

Mental health patients who lack a sustained level of treatment are using ERs as a last resort during crises. ERs frequently do not have the capacity or resident expertise to manage the influx. Rising expenditures in mental health treatment has galvanized lawmakers to take action.

Excerpt: “Three-quarters of emergency physicians responding to a poll of more than 1,700 ER physicians reported seeing patients at least once a shift who required hospitalization for psychiatric treatment. One-quarter, 21 percent, said they had patients waiting two to five days in the ER for inpatient beds.” … “Hospitals often don't have the beds or the professional expertise to treat patients needing psychiatric care, according to a study released Monday during a conference of the American College of Emergency Physicians.”

“Only 16.9 percent of emergency room physicians reported having a psychiatrist on call to respond; 11.7 percent reported having no one on call to respond to psychiatric emergencies.

“‘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. Renee Hsia, author of one of the studies presented at ACEP16. Of more than 65 million emergency department mental health visits reported, substance abuse comprised 41 percent of the visits; followed by anxiety at 26 percent; and depression at 23 percent, according to a Stanford University study.”

“Expenditures on mental health and substance abuse treatment reached $239 billion in 2014, up from $121 billion in 2003, according to the U.S. Department of Health and Human Services.”

“Congress has taken up the issue, passing the Helping Families in Mental Health Crisis Act in July. Lawmakers are expected to pass the package of mental health reforms before the end of the year. The Helping Families in Mental Health Crisis Act would provide more hospital beds for people dealing with a mental illness who need short-term hospitalization. It would also create a new federal position to oversee mental health, support grants for community health, assist with outpatient treatment, and allow state Medicaid managed-care programs to pay for short-term inpatient stays.

“In addition, the bill would support training for more mental health professionals; help providers more easily track available inpatient beds; support a wide range of programs to combat suicide, improve screening for mental illness in children; and push to reduce incarceration of nonviolent, mentally ill offenders.”

Source: Healthcare Finance News

WBB Take: A lack of adequate mental health coverage and stigma are combining with a national shortage of psychiatrists and psychiatric beds to create a surge in psychiatric cases boarded in EDs. Psychiatric beds have decreased year on year for several decades, and there are often long waiting lists for them. As a result, EDs are increasingly faced with emergency cases that involve both physical trauma and psychiatric comorbidities that complicate transfer and referral, and make discharge to the community problematic. Increasing psychiatric beds, raising and extending  the Medicare and Medicaid rates for psychiatric care, and better integration between EDs and psychiatric wards may alleviate the problem to a significant degree.


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