‘The numbers keep rising’: Patients waiting for psychiatric treatment crowd into emergency rooms

“We consistently have some of the highest volumes we’ve ever seen, and the intensity is even higher,” said Dr. Jason Tracy, chief of emergency medicine at South Shore Health, based in South Weymouth. “The numbers keep rising.”

According to data compiled by the Massachusetts Health and Hospitals Association, on May 2, 100 percent of emergency department beds staffed by patients were waiting for a psychiatric evaluation or being placed in a facility that could receive them.

Additionally, 557 patients were boarding the state’s hospital emergency departments on May 16 — another high-profile mark since the association began tracking numbers in October. More behavioral health patients were also climbing onto regular hospital floors. Immigrants are people who need inpatient psychiatric care but do not have beds available to them, forcing them to stay on regular hospital floors or in the emergency department, sometimes for weeks or even months.

In contrast to the spikes of COVID – which appear to be waning and waning with new variables – the sudden increases in the number of behavioral health patients coming to emergency rooms never seem to subside.

“We’ve seen what’s starting to look like a trend — that after every increase in COVID, the supply of behavioral health increases, but it doesn’t decrease in between,” Lee Simmons Yeomans, senior director of health care, told me. Massachusetts Health and Hospital Association Policy. “It just builds on itself.”

The housing of behavioral health patients is not a new phenomenon. A biannual survey conducted by the Massachusetts College of Emergency Physicians over the past 11 years showed that even before the pandemic, more than 100 patients with a behavioral health diagnosis had been admitted to emergency departments across the state during survey dates.

But the epidemic made matters worse. Since 2020, the number of residents in surveyed hospitals has ranged between 194 and 282 patients. Additionally, between 21 percent to 28 percent of emergency department beds have been filled by BHBs since 2020, compared to 6 to 18 percent before the pandemic.

People were also going up to the emergency room for longer, on average, for 78 hours, according to a January 2022 survey. This compares to between 26 and 34 hours before the pandemic.

Employment issues have played a major role in the ongoing behavioral health crisis, Yeomans said. According to a February 2021 Massachusetts Health and Hospitals Association survey of independent psychiatric facilities and psychiatric units in acute care hospitals, 208 licensed inpatient psychiatric beds — or 9 percent of those surveyed — were offline due to a staff shortage. By October 2021, that number had risen to 362 beds, or 14 percent of surveyed inpatient psychiatric beds.

A similar crisis is occurring in the outpatient workforce The community settings, Yeomans said.

“This is an unmistakable factor in all of this — the pre-pandemic workforce in behavioral health was challenging,” Yeomans said. “It has been exacerbated by the epidemic.”

There are also more people dealing with acute mental health crises, who are sicker than they were before the pandemic.

“It is the ongoing effects of the pandemic on people, but also the lack of access to community-based behavioral health care, which is also challenging and the increasing volume of people seeking care,” Yeomans said. “They are not receiving care in the community. By the time they reach the emergency department, they are in a more severe stage than they used to be.”

There is also insufficient investment in the behavioral health system, which lacks overall bed capacity as well as locations that patients can turn to when they are in crisis, so they can avoid hospital emergency rooms, said Dr. Christian Arpeles, chief of emergency services at Boston Medical Center. .

“My 20-year career, this is the worst [it has been]Arblas said. “And we see that in the violence that our employees witness.”

On Monday, there were 20 behavioral health patients in the emergency department at Boston Medical Center, more than double the capacity of the seven-bed EMS unit.

Statewide data shows at least a slight slowdown in pediatric behavioral health patients boarding at hospitals. But Amara Anosik, director of behavioral health advocacy and policy in the Office of Government Relations at Boston Children’s Hospital, said that may be because a The seasonal summer is slowing rather than declining.

There is still far More children are living at the border than before the pandemic. In 2019, there were an average of 19 Behavioral Health Patients per day at Boston Children’s. Now, there are about 40 to 60 a day.

On Monday, Anosik said 16 of the hospital’s authorized emergency beds are busy at the border. An additional 23 children were boarding hospital beds outside the emergency department.

The behavioral health workforce in particular has always been very fragile. But now with COVID, the challenges of working in a COVID environment as a frontline employee, service providers are exhausted.” “In the community, they are turning to default. Some do not accept insurance. People feel that the only place they can reach is the emergency department.”


Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her on Twitter Tweet embed.