Reducing Mounting Pressure on Emergency Departments Across the Country
Working within already strained hospital emergency departments (EDs), healthcare providers, ED physicians, and nurses are observing increasing rates of patients with mental health concerns or disorders such as anxiety, panic, and depression. The data reflects a surge of patients with mental health concerns in hospital waiting rooms and hallways: between 2007 and 2016, the proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9%. Mental health concerns were further exacerbated during the COVID-19 pandemic.
This mental health crisis is reaching across younger and older groups:
A patient with behavioral health needs who presents to the ED may face exceptional wait times or be inappropriately admitted due to a dearth of psychiatric specialists. One-third of Americans live in areas that lack access to psychiatrist. And pediatric psychiatrists are so difficult to access they are like “unicorns,” reported one pediatric primary care provider.
The mental health crisis is escalating costs for hospitals and potentially contributing to staff burnout. ED doctors and nurses are faced with supporting patients’ mental wellbeing in urgent situations, while also handling the influx of patients with critical or life-threatening physical conditions.
Alongside strain on treatment capacity, visits to the ED generally result in high costs—to the tune of an estimated $8.3 billion per year according to a 2019 analysis.
Once at the ED, patients with mental health concerns tend to stay longer in hospital waiting and treatment rooms. ED wait times for a patient with behavioral health concerns are on average two hours longer and patients are six times more likely to be transferred to other facilities, according to a University of Pennsylvania nationwide study. A 2012 study found patients with mental health needs wait an average of 3.2 times longer than other ED patients.
Regardless of whether they are admitted, transferred, or discharged, the average length of stay (Los) for patients with mental health concerns is significantly higher than for other patients (according to the same UPenn study). A 2017 NIH brief also reported that ED visits with a routine discharge to home tend to be less common for mental and substance use disorders (80.9% compared with 70.3% of other visits).
Wait time in hospital beds, hospital transfers, and extended inpatient care costs for patients with behavioral health needs are adding up. A 2017 NIH study found inpatient visits for ED patients with mental and substance use disorders represented a larger portion of costs for that population (12.5%), compared with inpatient admission costs for all ED visits (9.4%).
Patients with mental health concerns are sometimes presenting to the ED due to long waits to access psychiatric services through community or primary care referrals. Median wait time for psychiatry appointments outpaces wait times for referrals to all other specialties—landing at 73 days, which is more than 10 weeks.
The problem is local and national in scope, especially affecting rural populations. More than half of U.S. counties lack a psychiatrist, causing patients to have to seek care outside of their communities. Virginia’s Joint Legislative and Audit Commission found that, between September 2021 and July 2022 among 40 public providers, an average of 33 adults and 10 children were awaiting behavioral health care services daily.
Beyond the hospital walls, lack of mental health care services has societal costs. The White House has reported lack of mental health care is linked to poorer educational outcomes for school-aged children, impacts on families and parenting, and higher rates of homelessness and incarceration.
If you are reading this as a healthcare provider or hospital administrator, you have seen firsthand the urgent need for more timely access to psychiatric services. You are likely well aware of the rising tangible and intangible costs associated with care delays.
We are telling this story again because it doesn’t need to end with frustration and a persistent lack of resources. There are solutions available, supported by technology that can be within a healthcare provider’s reach.
The situation facing EDs across the country is daunting, but expanding access to behavioral health care via telehealth can reduce the burden on healthcare organizations, payers, and providers alike.
Expanding research evidence points to telehealth’s effectiveness. Supported by emergency legislation, telehealth emerged as a more commonplace healthcare delivery method during the COVID-19 pandemic.
Data collected since the height of telehealth usage during the pandemic suggests the method could be a “trusted approach” to some health care services, particularly behavioral health care, with populations showing high levels of satisfaction. And studies show telemental services like telepsychology are just as effective as in-person visits.
At Array, we strongly believe telemedicine is medicine. Telepsychiatry is a solution that can stem issues facing EDs across the country, while focusing on enhancing quality and continuity of care. Healthcare providers can plug into the power of virtual behavioral health through a consultative, psychiatrist-led care approach.
Timely access to a psychiatrist through telehealth has been shown to:
Additional benefits include:
We know this story is bigger than us, but we want to be part of the solution. We want to see more patients accessing the treatment they need using available and effective technologies. Our aim is to expand equitable access to quality behavioral health care in acute, outpatient, and at-home settings.
Array has been a pioneer in this space by offering telehealth services informed by industry-leading quality standards. In response to a need, Array’s Executive Chief Medical Officer James Varrell first offered telehealth services to a rural hospital in the late 1990s.
Today, Array serves as a partner to over 150 acute care facilities across the country—providing services in EDs, as well as outpatient and inpatient units. Learn how we can design a behavioral health solution for your hospital by engaging clinicians with the expertise and experience you are looking for.
We hope to connect you with a customized solution. Talk to us today to ensure the wait for quality behavioral healthcare is over—for you and for your patients.
Schedule a brief introductory chat with one of our specialists.
Did you know? Array’s virtual outpatient behavioral health practice is an option for post-discharge follow up care or preventive outpatient care for patients presenting with mild to severe anxiety, depression, trauma, mood disorders, comorbid nonactive substance use, and a list of other concerns.
Learn more by exploring our research-backed white paper on how behavioral care telehealth teams can help improve ED throughput and patient outcomes.
By: Geoffrey Boyce
Telehealth’s adoption has skyrocketed over the course of the pandemic. Although telehealth was a lifeline for many and filled in the gaps in our healthcare system, you cannot help but wonder where do we go from here? Despite its accelerated adoption, will telehealth have the same staying power after the public health emergency ends? The evidence and anecdotes point to a resounding ‘yes,’ especially when it comes to behavioral care.
Over the past 13 years in the industry, I’ve witnessed firsthand how telehealth has transformed the delivery of behavioral care. Research has long proven that telebehavioral care is just as effective as in-person care and checks out with higher retention rates. The COVID-19 crisis created an opportunity for telehealth to demonstrate its value without some of the traditional challenges that once limited its widespread adoption.
In early 2020, many laws and regulations were either temporarily instituted or suspended to promote, encourage, and legalize virtual treatment for behavioral health conditions. HIPAA flexibilities, 1135 waivers, and interstate allowances rolled out so that people could continue with their behavioral care provider, or pick up a new one, amid worsening mental health conditions nationwide. Even the DEA temporarily lifted multi-state registrations and the Ryan Haight Act fell under an exemption, which allowed psychiatrists and other prescribers to issue controlled substance medications without the usual requirement of seeing them in person – critical for both child psychiatry and addiction medicine.
The temporary telehealth allowances focused on making sure that patients could be seen at home. That is why industry groups, such as the American Telemedicine Association, are advocating at the federal and state levels to keep and expand these laws. Nearly 75% of providers say that no or low reimbursements would hinder them from offering telehealth after the pandemic if the current expansions do not remain.
Yet as waivers expire, and we emerge from home with a new location-agnostic reality, we must realize that telebehavioral care’s place has to be where the patient is — everywhere. Telebehavioral care’s place is in the home, the hospital, the PCP’s office, the community clinic and more. To truly serve patients’ mental health needs, telehealth regulation must support care across the now-expanded continuum.
The story of one New Jersey mother illustrates the need for expanded access to telebehavioral care. Despite having at-home virtual care and medication for her adolescent son struggling with autism spectrum disorder and suicidal tendencies, this mother ended up in an emergency department to save her son from suicide twice.
The first time, she and her son waited for days in an emergency bed for her son to be seen by a social worker, not a psychiatrist — a common occurrence as hospitals shoulder the burden of the nationwide mental health crisis amid a shortage of behavioral care professionals. On the mother-son pair’s second visit, the hospital had implemented a telepsychiatry program that allowed her son to be seen in just a matter of hours by a psychiatrist who evaluated him and sent him home with a concrete treatment plan and next steps.
The second visit was made possible by legislation that allowed for the psychiatrist to see the patient virtually along with the appropriate authority to make the right placement decision, while also requiring reimbursement for that care. These hospital EDs are just one setting in need of behavioral care support. Data shows that one out of every four primary care visits in the U.S. are for mental health conditions. FQHCs regularly serve populations with higher incidences of behavioral care needs. In short, pro-telehealth legislation does not just expand patients’ access to behavioral care clinicians, it expands other providers’ access too.
Telehealth is a lifeline for so many of the patients that are often left behind by our healthcare system. It is crucial to extend the telehealth-friendly regulations well after the COVID-19 crisis has passed so that there can be broader, timelier, and more convenient access to the scarce resource of behavioral care. Ensuring that physicians, psychiatrists, clinics, hospitals, and other healthcare providers offering telehealth continue to be paid and allowed to practice virtually is one of the ways that our industry protects telehealth’s future and secures a permanent place for the vitally important behavioral care Americans need — wherever and however they need it.
Geoffrey BoyceGeoffrey Boyce is the CEO of Array Behavioral Care, the leading telepsychiatry service provider in the United States with a mission to transform access to quality behavioral care. Boyce is a leader in telemedicine advocacy, education, and reform initiatives. He serves as a national voice promoting telemedicine and telepsychiatry and regularly interacts with state and local healthcare regulators and administrators. In 2017, he received the Industry Leader Award from the American Telemedicine Association and is currently an active participant in several ATA Special Interest Groups and Workgroups including: the Telemental Health SIG and the controlled substances prescribing and telehealth workgroup. He also serves on the advisory board of directors for the Mid-Atlantic Telehealth Resource Center (MATRC). In 2018, he was appointed to the New Jersey Telehealth Review Commission. Boyce frequently speaks about the potential of telemedicine and the best practices for establishing new programs.