October 22, 2021
The growing burden of mental health on emergency departments
The stress, disruption, isolation, and lives lost during the pandemic have exacerbated longstanding challenges in access to mental healthcare. In the graphic below, we highlight how COVID has impacted the state of mental health across generations. Younger Americans are faring much worse. This week, the nation’s leading pediatric professional societies declared a national mental health emergency for children and adolescents, and nearly half of “Generation Z” report that their mental health has worsened during COVID. Mental health-related emergency department (ED) visits increased during 2020 across all age groups, with the steepest rise among adolescents. Because of a national shortage of inpatient psychiatric beds, patients with mental health needs are increasingly being “boarded” in the ED—even as nearly two-thirds of EDs lack psychiatric services to adequately manage patients in crisis. Case in point: research on behavioral health access in Massachusetts shows one in every four ED beds is now occupied by a patient awaiting psychiatric evaluation. ED boarding of patients in mental health crisis not only delays necessary care, but leads to throughput backups in hospitals, and increases caregiver stress and burnout. Access to inpatient treatment is most challenged for children and adolescents, as well as “med-psych” patients, who also have significant physical health needs that must be managed. New solutions have also emerged during the pandemic: telehealth doesn’t just increase access to outpatient therapy, but also enables psychiatrists to evaluate emergency patients virtually. In the long term, a three-pronged approach is needed—new virtual solutions coupled with expanded inpatient capacity, and greater community resources to address the social needs that often accompany a behavioral health diagnosis.