Behavioral Health in the ED

414% 

That’s the percentage increase in suicidal patients presenting to United States emergency department (ED) over the last decade.1 

Yes, you read that right. 414%.   

Total ED visits with a presenting problem of suicidal ideation increased by 414% from 2006 to 2014.2  

Additionally, total ED visits related to behavioral health disorders and/or substance abuse disorders (excluding suicidal ideation) increased by 44%3 in the last decade.  

About 1.5 million ED visits a year in the US are related to behavioral health and substance use. These patients are sick, and their care is complex. Getting them better efficiently and correctly is complicated. 

ED patients with substance use or behavioral health complaints often have multiple psychiatric conditions at the same time (imagine someone with active polysubstance use/abuse, a sub-optimally managed chronic behavioral health condition, and a decompensated event such as a suicide attempt). Their understanding of the complicated medical system around them is typically suboptimal. They usually have many chronic medical problems (like diabetes, lung disease, and heart disease) which are often poorly managed due to the underlying psychiatric condition, further compounding their care needs. And their fragmented healthcare delivery desperately needs coordination and integration. Meanwhile, the patients have several associated social determinants/influencers of health which challenge their abilities to thrive in our community health networks.  

Thus, stabilization and ED disposition takes time. Sometimes, a lot of time. 

Amidst this increase in ED demand, the bed capacity for our nation’s inpatient psychiatric facility system is decreasing, as is the total number of practicing psychiatrists. This has led to a perfect storm of “boarding” (long waits and holds for admissions) for ED patients with active behavioral health needs. ED boarding negatively effects not only the emergency department but also the entire hospital. It slows the effective capacity to care for the next incoming patient. As this capacity and boarding crisis escalates, the ED safety net becomes less fluid, less open, and less safe for all of us.  

The emergency medicine community knows this story well. And we need some help. 

I’m an emergency medicine physician. I see this crisis play out each shift. Because of these challenges, I’m such a strong proponent of ED-based telepsychiatry. That’s why I agreed to join the board of MindCare, a specialist telepsychiatry provider that is committed to setting a new standard of care in telebehavioral health. 

MindCare gets our psychiatric colleagues to the bedside early and consistentlyThese psychiatrists collaborate with the emergency medicine team to treat and stabilize along a current sophisticated base of medical evidence. ED-based telepsychiatrists can help us with our choice of stabilization medications for the acutely agitated and disruptive psychotic patient. They can help us with treatments for our patients withdrawing from opioids or struggling with opioid use disorder. And they can help us navigate a non-inpatient option for our patients who do not need inpatient care. 

MindCare is providing solutions to the behavioral health crisis in front of us. Our patients and our emergency departments are grateful!