Mental illness taxing EDs, affecting other patients

If it seems you’re seeing more patients with mental illnesses recently, you’re not imagining it. The number of people with mental illness seeking care in the ED has surged recently, and the increase is taking a toll on other ED care, says J. Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX.

"We are reaching a breaking point where we may not have the resources or the surge capacity to respond effectively," Hancock says. "This affects everyone’s access to lifesaving medical care."

EDs across the country are trying to cope with more mentally ill patients, says Howard Peth, MD, JD, assistant professor of emergency medicine at the University of Missouri School of Medicine in Columbia, and chair of legal committee for the American College of Emergency Physicians in Irving, TX.

The increased number has a direct effect on ED flow through, he says.

"I’ve heard of hospitals where patients wait in the ED for 72 hours, specifically because there are mentally ill patients waiting for transfers," Peth says. "That’s three days in the ED because we don’t have the resources for these patients with mental illness."

Hancock points to a recent survey conducted by ACEP and the American Psychiatric Association in Arlington, VA; the National Alliance for the Mentally Ill, also in Arlington; and the National Mental Health Association (NMHA) in Alexandria, VA.

Sixty percent of the emergency physicians surveyed reported that the increase in psychiatric patients is negatively affecting access to emergency medical care for all patients, causing longer wait times, fueling patient frustration, limiting the availability of hospital staff, and decreasing the number of available ED beds, says Hancock.

Two-thirds (67%) of emergency physicians attribute the recent escalation of psychiatric patients to state health care budget cutbacks and the decreasing number of psychiatric beds.

Nowhere else to go?

One in 10 report there is nowhere else in the community where people with mental illness can receive treatment.

Seventy percent of emergency physicians reported an increase in people with mental illness boarding, and more than 80% reported that boarding negatively affects the care of ED patients.

That was the conclusion of 97% of those who reported a rise in the boarding of psychiatric patients over the prior six to 12 months.

The report also finds that psychiatric patients board in hospital EDs more than twice as long as other patients. In addition, emergency physicians say their staff spend more than twice as long looking for beds for psychiatric patients than for nonpsychiatric patients.

The findings underscore the serious consequences of state budget cuts to programs such as Medicaid, says Michael Faenza, MSSW, president and CEO of the NMHA. "These budget cuts force people with mental illness to seek care in emergency departments because they have nowhere else to turn," he says. "Nobody wins when this happens."

More than 90% of survey respondents said boarding people with mental illness reduces the availability of emergency staff, decreases the availability of beds in the ED, causes longer waits for patients in the waiting room, results in patient frustration, and increases the number of times the hospital diverts ambulances to other hospitals.

At press time, the entire survey report was to be posted on the ACEP web site at


For more information on psychiatric patients in the ED, contact:

  • Michael Faenza, MSSW, President and CEO, National Mental Health Association, 2001 N. Beauregard St., 12th Floor, Alexandria, VA 22311. Phone: (703) 684-7722. Web:
  • J. Brian Hancock, MD, President, American College of Emergency Physicians, 1125 Executive Circle, Irving, TX 75038-2522. Phone: (800) 798-1822.