Patients in Need of Mental Healthcare Face Long ER Waits, Study Says

In some cases, they wait up to five times longer than other patients.
Emergency room

Emergency room photo via istock.com/MJFelt

A new study further highlights the shortcomings of mental healthcare in Massachusetts.

The research, published in the Annals of Emergency Medicine and led by a group of local doctors, says patients in need of mental health resources face significantly longer emergency room waits than patients seeking physical care. On average, these patients stay in the emergency department between 16.5 and 21.5 hours before being placed, while patients with other conditions idle for, on average, just four hours.

Emergency room “boarding”—which refers to the time between a hospital deciding to admit a patient and actually admitting or transferring him to an inpatient unit—is the primary contributor to these waits, the study says. Medical examinations and clearance account for a fairly small portion of each stay.

Boarding is a known problem in medicine, contributing to ER overcrowding, backlogs, and weakened patient care. The frequency with which mental health patients are boarded, the study says, suggests that “although the notion of mental health parity has received greater attention in recent years, the inequity in care for this particularly vulnerable group of patients persists.”

The study also revealed another troubling reality: Uninsured patients and those with Medicaid (MassHealth) insurance face the longest delays of all, lasting a day or longer with disproportionate regularity, despite regulations meant to prevent hospitals from treating patients differently based on Medicaid status. That’s especially problematic, given that MassHealth covers some of the state’s sickest and most vulnerable individuals.

The study did not offer a full explanation for these disparities, but finances probably play a major role. “If you have no insurance or insurance that is going to pay less, you are not going to be as competitive for getting that bed,’’ coauthor Kristin Dwyer told the Boston Globe.

The care gap is likely also indicative of the general state of mental healthcare in Massachusetts—which is to say, flawed. Massachusetts’ mental health spending is widely considered subpar, and beds devoted to mental illness are sparse. Of the 10 hospitals included in this study, none have more than 56 mental health beds, and most have closer to 25.

The study examined 10 unaffiliated Massachusetts hospitals, ranging in size and scope, during a two-week period in 2012. During that time period, 871 patients came into the hospitals due to mental illness.


Jamie Ducharme Jamie Ducharme, Contributor jducharme@bostonmagazine.com