Mass. bottleneck for mental health patients in ERs shrinks, but problems persist
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More than one-third of people who went to the emergency room for mental health conditions in 2024 spent 12 hours or more waiting for treatment, per a new report.
Why it matters: These patients wait on average more than a day for inpatient beds or other treatment in Massachusetts, among the longest wait times in the nation. Any wait longer than 12 hours is referred to as boarding.
Driving the news: 37.5% of patients who went to the emergency room for mental health issues in 2024 were boarded, per new data released by the state's Health Policy Commission.
- It's below a high of 40% in 2022, but still higher than the 32% reported in 2020.
What they're saying: "While stakeholders across the health care system agree that this is a significant challenge and rates of boarding have grown since 2020, we are also starting to see modest improvements," David Seltz, executive director of the HPC, said in a statement.
Zoom in: Some of the biggest reasons for delays, per the HPC, are a lack of inpatient beds, long waits for a provider to assess a patient and waiting for medical clearance to send a patient to a psychiatric facility.
- It can also take a while to stabilize a patient actively in crisis or showing symptoms of substance use.
By the numbers: Nearly half of behavioral health patients who were boarded in the emergency department in 2024 weren't discharged to inpatient care, and one-quarter were sent home.
- The average length of stay for behavioral health ER patients who were sent to an inpatient or psychiatric bed exceeded 30 hours.
Yes, but: The HPC noted several changes to the health care system have helped slightly shrink the bottleneck. They include:
- A 2022 law eliminating the need for prior authorization for acute mental health treatment and stabilization services
- The launch of a behavioral health helpline
- And the ramp-up of community behavioral health centers as the "front door" for treatment in 2023.
Since then, the centers' mobile crisis teams have diverted tens of thousands of people in crisis from emergency rooms, says Lydia Conley, president and CEO for the Association for Behavioral Healthcare.
- The organization represents 80 mental health and addiction treatment organizations, including 25 of the state's 27 behavioral health centers.
- In fact, 95% of those evaluations by the mobile team have diverted people away from emergency rooms or inpatient hospitalization.
- Law enforcement have diverted more than 1,700 people to these centers instead of taking them to emergency rooms since 2023.
Still, the system needs improvements to reduce care delays for behavioral health patients, per the report.
- Prior authorization may still be required for some outpatient programs, which could prolong a patient's stay in the emergency room, per the report.
- Patients who are homeless, who have physical or developmental disabilities and who need residential care are the hardest to place, as most hospitals with beds are not equipped to meet their needs.
- The HPC recommended several improvements, including making sure ambulances can send patients to the hospitals best suited to treat mental health conditions, rather than to the closest emergency rooms, and clarifying payment rules for mental health treatment.
What we're watching: The state launched a behavioral health treatment and referral platform with contractor PointClickCare last year.
- David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said it's helped speed up the boarding process.
- The behavioral health centers are expected to start using the platform in 2026, Conley says.