Massachusetts Mental Health Patients Wait Longest for Hospital Beds

Emergency rooms are not an ideal place to handle mental health crises. The facilities and staff are often not effectively equipped to manage people with erratic and unpredictable behavior, who would be better off in a specialized mental health placement.

But according to a new report published Wednesday in the Annals of Emergency Medicine, mental health patients in Massachusetts typically stay much longer in emergency departments of hospitals waiting for a bed in an appropriate setting than do patients with other health conditions.

The study's authors, led by Chairman of the Academic Department of Emergency Medicine Dr. Mark Pearlmutter at Tufts University, found that mental health patients waited almost four times as long for an inpatient bed and more than five times as long to be transferred to another facility compared to other patients.

They examined 885 patients in their study across 10 different hospitals in the state.

"Boarding, the practice of prolonged waiting in the emergency department for an inpatient hospital bed or transfer to another facility, is a pervasive public health problem that disproportionately affects mental health patients," Pearlmutter said in statement.

"Mental health patients....are routinely held in [emergency departments] for days or even weeks without access to definitive psychiatric care," the authors write.

The practice of boarding, Pearlmutter said, "is a common problem nationwide, as are shortages of mental health beds for patients having psychiatric emergencies. Uninsured patients and those with Medicaid had significantly longer waits in the emergency department and were more than twice as likely to remain in the ER waiting for an inpatient bed than privately insured patients."

On average, patients with physical health issues waited 4.2 hours for a bed, while mental health patients waited 16.5 hours. To be transferred to another facility, physical health patients had an even shorter wait on average of 3.9 hours, while mental health patients had an average wait of 21.5 hours.

And if you're uninsured or on Medicaid, you're much more likely to have to stay in the ER for a mental health condition for more than 24 hours.

"While the notion of mental health parity has received some attention in recent years, the inequity in care for this particularly vulnerable group of patients persists," Pearlmutter said. "The wait for inpatient treatment is the largest driver of delays and crowding for emergency patients, particularly for the uninsured and underinsured. Support for community-based initiatives offering mental health resources to patients is urgently needed."

The authors of the study also point out that housing mental health patients in emergency departments for extended periods strains their resources, which can result in worse treatment for other patients with potentially life-threatening conditions. It can lead to more medication errors and be dispiriting for nurses and physicians.

The state has convened a workgroup on the matter of emergency department boarding to examine the roots of the problem and particularly to address the unique hurdles children face in getting access to treatment. Its recommendations are due to come out in February.

“For the past nine months the state has been intensely monitoring emergency department boarding to understand the root causes and eliminate barriers that are contributing to wait times," a spokesperson from the state's Executive Office of Health and Human Services said in a statement.

The statement continued: "The data all point in the same direction and the Commonwealth will use all its powers - its bully pulpit, its convening powers, its licensing authority and all other levers – to bring about sustainable solutions as we manage the immediacy of the current issues.”

The statement notes that the issue is not limited to public sector insurers. The department declined to respond to questions about whether it would specifically address the additional challenges faced by those who are uninsured or on Medicaid.

Photo credit: Joseph Scozzari (public domain)