Psychiatric patients’ demand for emergency-room care presents a problem the Affordable Care Act won’t solve

Psychiatric patients’ demand for emergency-room care has been a concern in hospitals, and it’s going to get worse. Even though ERs are not properly equipped to help psychiatric patients, people still often go there with psychiatric concerns. Most ERs simply lack room to deal with such situations. According to a survey, 84 percent of emergency physicians say they have psychiatric patients “boarded” in their emergency departments awaiting transfer to a mental-health facility, Adrianna McIntyre writes for Vox.


“People having a mental-health crisis seek care in emergency departments because other parts of the health care system have failed them,” said Alex Rosenau, president of the American College of Emergency Physicians.

A psychiatric patient who shows up to the emergency room may require immediate care at the hospital, and sometimes there isn’t an open bed in the right department. Those shortages often necessitate psychiatric patients to wait in the emergency room, or board, until space elsewhere opens for them. Both the closure of psychiatric facilities and diminished state funding have contributed to the issue. “Between 1955 and 1997, total state spending on mental health fell 30 percent, a period during which most health spending grew rapidly,” McIntyre writes.

If hospitals don’t figure out how to deal with the problem, it’s going to get worse. In fact, experts say the implementation of the Patient Protection and Affordable Care Act will only exacerbate the problem. Some studies reveal that insured patients are more inclined to go to the emergency room—even for non-urgent issues—because the cost usually isn’t as high. Lower-income people are even more likely to do that, and this population will comprise many of the newly insured citizens.

Though hospitals want people to use the health system properly, they also want to make sure patients do visit the ER when it really is necessary. “We don’t want to impose any barriers on people going to the emergency room,” said Hans House, a clinical professor at the Iowa University Carver College of Medicine. “We don’t want people to be afraid to go to the ER.”

The Affordable Care Act has provided more funding for reimbursement of emergency psychiatric care in Medicaid, a service the public program doesn’t generally cover. However, this doesn’t address the lack of space in emergency departments. “We know that a lack of psychiatrists available and staffing patient beds is a barrier,” House said. “That’s a personnel issue.” (Read more)