Redesigning Hospital-Based Mental Health Care through Telehealth

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.  

A Mental Health Crisis Reaching EDs 

This mental health crisis is reaching across younger and older groups: 

• Mental health visits in pediatric EDs increased by 8% annually between 2015 and 2020, compared with an increase of 1.5% annually of all other ED visits.  
• Adolescent girls are facing unprecedented rates of persistent sadness, suicidal thoughts, and sexual violence. 
• Among older generations, an estimated 20% of people 55 years or older experience some type of mental health concern and older men have the highest suicide rate of any age group.  

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.  

Disproportionate Costs of Mental Health Care in EDs 

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%).   

The National Mental Health Care Landscape 

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.  

Why are We Telling this Story? 

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.  

Increase Access and Support Onsite Hospital Providers 

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:  

• Lower costly inappropriate admissions,  
• Decrease hospital wait times,  
• Improve ED throughput,  
• Reduce risk and liability, and 
• Improve patient experience.  

Additional benefits include: 

• Filling gaps in care resources, 
• Buttressing continuity of care and extending treatment to community and home, and  
• Easing the overwhelm on healthcare providers. 

Array Can Help 

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. 

Not ready to reach out yet?  

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.