It’s not news that the shortage of behavioral healthcare providers, the prevalence of behavioral health issues, and the cost of behavioral healthcare treatment strains already overcrowded emergency departments.

Because most EDs lack adequate training and resources to care for mental health patients efficiently, psychiatric patients often face lengthy wait times and longer ED stays.

Though an acknowledged problem, it is rarely top of mind in terms of investment. However, behavioral health poses a real and impactful challenge to hospital resources and to the quality of care patients receive. To alleviate behavioral health strain on your ED and better serve patients, it’s crucial to face the facts behind the challenge and proactively implement solutions.

Behavioral Healthcare Facts

  • An estimated one in eight ED visits involve a mental health or substance abuse condition;
  • Psychiatric patients are held (or “boarded”) in the ED waiting for an inpatient bed one or more times per day;
  • The vast majority of hospitals do not have a psychiatrist on call to respond to mental health emergencies in the ED;
  • A severe shortage of beds means patients needing mental healthcare wait two hours longer on average (and in some cases as much as six) in the ER than people needing general medical care.

Adding to the challenge, behavioral health patients are less likely to have health insurance compared to those presenting with physical issues. According to the U.S. Department of Health and Human Services, expenditures on patients with mental health or substance abuse problems have risen sharply in the past few years.

If there is good news to be had, it's that the healthcare industry and lawmakers alike are beginning to recognize there is an opportunity to improve access and scalability of care for psychiatric patients.

Behavioral Health Solutions for EDs

The lack of adequate behavioral healthcare solutions is a systematic issue that requires industry-wide remedies. However, there are impactful solutions individual facilities and healthcare systems can implement more immediately to improve patient care quality and lessen pressure on EDs.

Process Improvement

Examine policies and procedures surrounding psychiatric care in your facility/system and establish a systemic standard for coordinating behavioral healthcare.

To get buy-in from key hospital stakeholders, create a business case for process change by answering questions like these:

  • What percent of patients come into your ED with behavioral health issues? (insured, uninsured, prisoners, etc.)
  • What is the LOS of those patients? (Average wait times, hours patients are boarded in the ED before evaluation, inpatient op admissions, overall LOS)

These answers help illuminate the true cost of insufficient behavioral health resources and build the business case to invest in defining and executing improved behavioral healthcare processes.

Once buy-in is established, hospitals should invest time and resources in defining a process that helps ED clinicians and staff recognize and expediently treat psychiatric patients, stabilize agitated patients, and know-how and when to bring in outside mental healthcare professionals.

Telemedicine Solutions

Telemental health options are increasingly being embraced to improve access and scalability of mental healthcare, particularly in rural or HPSA areas.

Providing remote mental healthcare services (usually via a secure audio or video platform) by psychiatrists, psychologists, social workers, and other mental health professionals ensure that clinical care, medical education, monitoring, and provider consultations are available anytime, anywhere.

The use of telemental solutions also helps guarantee that psychiatric consults happen earlier in the process, enabling providers to observe patients, ask diagnostic questions, and, in some cases, write a prescription on the spot.

Community Partnerships

Partnerships with community-based mental health organizations that specialize in behavioral healthcare delivery is an outstanding way to supplement inadequate behavioral healthcare resources.

This approach benefits the hospital, the patient, and the community mental health providers by bridging gaps in the continuum of care and better-utilizing resources on all counts.

One drawback is that the partnership option is better suited to larger markets with greater access to specialty hospitals, as rural areas or smaller markets typically don’t have behavioral health specialists or specific care facilities nearby.


The fact that EDs across the nation are a de facto safety net for mental healthcare and most are underprepared to serve this population is a national crisis that requires system-wide attention and intervention.

Process improvements that leverage existing resources, use of telemedicine, and partnerships with community mental health resources are three innovative solutions healthcare professionals are employing today to alleviate the strain.

These measures alone are insufficient in and of themselves, however. Ultimately, restoring mental healthcare funding and enhancing legislation at the state and federal level are the only solutions that will stem this continually rising tide.