Emergency Departments and the Growing Mental Health Crisis

While the COVID-19 pandemic certainly impacted Americans’ mental health, ED visits for psychiatric needs had been steadily climbing for years beforehand. In 2007, mental health visits comprised 6.6 percent of all ED visits. By 2016, that number almost doubled to 11 percent.1,2 In a 2015 poll, 70 percent of emergency physicians reported that psychiatric patients were boarding on their last shift, with more than half reporting average boarding times of up to two days.3

During the pandemic, mental health issues played an even larger role in emergency medicine. Rates of anxiety and depression significantly increased, with 40 percent of U.S. adults reporting they struggled with mental health or substance abuse in June 2020, and 10.7 percent reporting they had seriously considered suicide.4 While overall ED visits declined because of the pandemic, mental health visits remained disproportionately high.5-7

Now that ED visits have stabilized closer to pre-pandemic volumes, it is too soon to have a precise understanding of the current state of ED visits for mental health issues. One large review suggests that population-level mental health has rebounded close to pre-pandemic baselines, with only a slight increase in depression.8 This is not necessarily good news; if we’re right back where we started prior to the pandemic, we are still not in a good place.

It is clear to practicing EM physicians that caring for patients with mental health issues remains a pressing concern. Too many patients wait far too long in our EDs to receive necessary mental health care, causing needless suffering for both patients and caregivers. That’s why ACEP is prioritizing mental health as a key focus for 2023, dedicating significant resources to the issue.

One simple way you can mark Mental Health Awareness Month is by making sure you know about the helpful tools and resources available to assist with emergent behavioral health:

  • ACEP’s Mental Health & Substance Abuse Information Papers web page is a very useful collection of articles offering insight into several pertinent ED practices, including:9
    • Recent reviews of ED psychiatric care
    • Advice on medication therapy during psychiatric emergencies
    • Assessment of psychiatric safety in suicidal patients
    • Practical solutions to boarding of psychiatric patients
  • ACEP has relevant clinical policies and policy statements associated with ED Psychiatric Care:
    • Critical Issues in the Diagnosis and Management of Adult Psychiatric Care in the ED10
    • Adult Psychiatric Emergencies11
    • Pediatric Mental Health Emergencies in the ED12
  • ACEP’s advocacy efforts related to behavioral health care are documented on its website and will be recapped in person at the 2023 Leadership & Advocacy Conference.13
  • The Coalition on Psychiatric Emergencies (CPE) is made up of a group of leaders in emergency medicine, psychiatry and patient advocacy who are focused on improving the treatment of psychiatric emergencies for patients and emergency providers.14
  • ICAR2E is a point of care tool for managing suicidal patients in the ED.14

Behavioral Health is among the top priorities for ACEP President Chris Kang, MD, FACEP, and ACEP’s Board of Directors. ACEP members who attended recent Council meetings can attest to the number of resolutions created around emergent behavioral health care. From these resolutions, several working groups were formed. Multiple objectives are being addressed by ACEP committees and will result in new and/or updated ACEP policies and publications over the next several months. A new clinical policy, “Critical Issues in the Evaluation and Management of Adult Prehospital or ED Patients Presenting with Severe Agitation,” is open for member comments until May 25, and the following resources are currently being updated: