From ED Boarding to Breakthroughs: Key Takeaways from Becker’s Behavioral Health Summit Panel

Recently, I had the opportunity to join a fantastic panel at Becker’s CEO + CFO Roundtable, where we tackled one of the toughest challenges in healthcare today: how emergency departments (EDs) can better serve patients in behavioral health crisis. This post is a summary of that lively discussion—packed with real-world lessons, data, and a few “aha!” moments from the front lines. Whether you’re a health system leader, clinician, or just curious about what’s happening in the ED, here’s what stood out.

Let’s be honest: EDs have become the default front door for behavioral health, not because they’re designed for it, but because there’s nowhere else for people in crisis to go. Psychiatrist shortages, limited inpatient beds, and long waits for outpatient care mean patients often board in the ED for hours or days. That’s tough on everyone—patients, families, and staff.

It’s a perfect storm of factors: 

• More people are showing up in crisis. 

• Many EDs don’t have enough psychiatric specialists or resources to keep up. 

• And after discharge, too many patients fall through the cracks, only to return in crisis. 

All of this leads to “boarding”—patients waiting hours (sometimes days) for the right care. It’s costly (about $2,265 per psych patient in lost throughput), stressful for staff, and, most importantly, not safe for anyone.

For years, the standard playbook was “call the psychiatrist.” But with demand rising and workforce shortages everywhere, that model just isn’t sustainable. We need a new approach—one that’s scalable, flexible, and actually works for the realities of today’s ED.

Here’s the good news: change is possible, and it starts with rethinking the ED’s role. Instead of being a holding pen, the ED can become a “stabilize-and-connect” hub—somewhere patients get rapid assessment, the right intervention, and a warm handoff to the next step in their journey. 

How? By embedding virtual psychiatric support, streamlining workflows (think: consults and documentation right in Epic), and focusing on evidence-based care. The result: shorter stays, fewer unnecessary admissions, and better continuity for patients and staff alike.

One of the biggest takeaways from our panel was the power of team-based care. where independently licensed clinicians (like LCSWs) and psychiatrists work together, each playing to their strengths. In this model, most patients start with a master’s-level clinician for assessment, risk stratification, and crisis intervention. Psychiatrists are available for the most complex or high-risk cases, or when medication management is needed. 

Panelists from across the country echoed the value of this approach. For example, Dr. Matt Bole, Chief Medical Officer at Salem Health, described how their ED eliminated psychiatric boarding entirely by bringing together an ER physician, LCSW, psychiatric clinician, and security—all working together to make rapid, informed decisions. Their experience shows that with the right team and strong community partnerships, boarding doesn’t have to be the norm. 

This isn’t just about efficiency (though it absolutely helps with that). It’s about making sure every patient gets the right care, at the right time, from the right provider. Clinicians get to work at the top of their license, which means less burnout and better outcomes all around.

Picture this: a patient with severe anxiety but no acute safety risk is seen quickly by a licensed therapist, gets a thorough assessment, a safety plan, and a warm handoff to outpatient care—all within a couple of hours. No unnecessary wait for a psychiatrist, no avoidable admission, and the ED bed is freed up for someone else in need. 

Now, if a patient comes in after a suicide attempt, the team escalates to a psychiatrist right away for medication management and possible admission. It’s all about matching the right resource to the right need, every time.  

As another panelist Michelle Schafer, Chief Executive Officer at Mental Health Cooperative noted, ensuring patients leave the ED with a clear wellness plan and strong connections to follow-up care is critical to reducing recidivism.

• Faster access: Patients aren’t waiting hours for an evaluation. 

• Better use of resources: Psychiatrists focus on the cases that truly need their expertise. 

• Top-of-license care: Clinicians practice to their full scope – master’s level clinicians handle assessment, crisis intervention, and care planning, while psychiatrists focus on complex cases. This approach streamlines care delivery and improves efficiency and outcomes for patients and staff. 

• Fewer unnecessary admissions: More patients can be safely discharged with a plan. 

• Lower costs and less burnout: Teams feel supported, not stretched. 

• Smoother transitions: Discharge planning and follow-up are built in, so patients don’t fall through the cracks.

• ED length of stay drops by as much as 75%.

• Unnecessary psychiatric admissions go down, safe discharges go up. 

• Boarding times shrink, and staff satisfaction improves. 

If there’s one thing I hope leaders take from our panel, it’s this: team-based, top-of-license care isn’t just a nice idea—it’s a practical, proven way to move from bottleneck to breakthrough. It’s about using the resources you have in smarter ways, supporting your teams, and—most importantly—giving every patient the timely, appropriate care they deserve. 

Thanks for reading! If you have questions or want to share what’s working in your ED, I’d love to hear from you.