719 psychiatric patients are stuck in emergency rooms awaiting treatment, according to a report from Mass.

The first of what will be weekly reports from Massachusetts hospitals shows 716 patients who need and cannot get acute psychiatric care. 174 children and 542 adults presented to the emergency room in distress and are still there because the treatment programs they need are comprehensive.

“Behavioral health has become the epidemic within the pandemic,” says Leigh Youmans, who leads work on this issue at the Massachusetts Health and Hospital Association (MHA). “We have seen significant amounts of behavioral health needs increase in all acute care hospitals across the state.”

(Graphic courtesy of the Massachusetts Health & Hospital Association)

The problem is worse in some areas and in some hospitals. At a peak in the past month, 49% of emergency room beds in southeastern Massachusetts were occupied by patients on a waiting list for psychiatric care, compared with 24% in western Massachusetts. The MHA says one hospital reported 87% of beds used for what’s called psychological boarding school last month.

Detaining patients in need of mental health care limits space for those presenting with chest pain, early signs of stroke, wounds and other common emergencies.

“This problem is one of the main problems our hospitals are currently facing,” says Youmans.

The mental health boarding school has increased wait times in emergency rooms. Staff say more and more people are giving up and leaving.

“This has caused us to have an extremely high number of ‘unseen leftovers’,” says Dr. Joe Tennyson, who runs the UMass Memorial emergency rooms in Leominster and Clinton, “because we can’t get patients back in. spaces to see them. “

Staff shortages are part of the embarkation problem. Patients can wait a day for a psychological assessment, which is usually the first step in determining what they need and which programs would be best for them.

Tennyson, who sits on the Massachusetts College of Emergency Physicians board of trustees, says he’s happy to have this statewide view, but that doesn’t tell the whole story. What’s missing is how long patients are stuck in the emergency room. Tennyson says one to two weeks is common. But he had an 18-year-old autistic boy who was interned for five months and has just found a placement. Tennyson says placement of children and adolescents is still particularly difficult.

“These are children who do not see the light of day,” he says. “Their movements and activities are restricted. Their educational efforts are limited to what we can safely provide. We are doing the people a terrible disservice.

(Graphic courtesy of the Massachusetts Health & Hospital Association)
(Graphic courtesy of the Massachusetts Health & Hospital Association)

Some patients say that boarding worsens their anxiety, depression, and other mental health issues. Lisa Lambert, executive director of the Parent / Professional Advocacy League, says adding data to the stories of patients languishing in emergency rooms will illustrate the extent of the problem and help push for needed change.

“We wouldn’t ask a heart patient or a cancer patient to sit in an emergency room and wait for days,” Lambert says.

One of the reasons for the difference is the money. Hospitals say they are losing money on mental health care. The Baker administration has increased psychiatric reimbursement for patients covered by MassHealth. That should help fund 300 new psychiatric beds this year and next – just enough to help half the children and adults get on board now.

But it’s not clear whether hospitals will be able to find the staff needed to open these beds. And there have been other setbacks. Cambridge Health Alliance had planned to add psychiatric beds to its Somerville hospital by the end of the year, but a water main rupture earlier this month is causing delays.

To reduce mental health internship, MHA recommends creating a trust fund to help increase staff, task force to review reimbursement rates, changes to reduce denial of coverage, insurance and rules that would facilitate the expansion of mental health services.

The Baker administration says it has a plan that includes provisions to both expand preventive mental health care and increase treatment in emergency care behavioral health clinics. These centers could handle some emergency needs to avoid overcrowding hospital emergency rooms.

The MHA says it is working closely with the state on solutions to this perennial problem. The Baker administration has yet to comment on the MHA report


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