Emergency room waits for mental health care are still too long

As of 2024, there were fewer mental health patients stuck waiting in hospital emergency departments than in 2022. But Massachusetts still had some of the nation’s longest waits, and behavioral health patients with unique needs — like seniors, pregnant women, or children with autism — too often can’t obtain timely treatment.

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Ensuring treatment for people with mental health crises is an issue of parity — someone who comes to the hospital with a stroke or broken leg is less likely to wait for days than someone with schizophrenia or depression, according to the Health Policy Commission data.

The problem of bottlenecks in the mental health system is also complicated, and the answer must be multifaceted: ensuring patients can obtain timely care in nonhospital settings, ensuring that insurers pay providers adequately for services for complex patients, and eliminating regulatory barriers, such as those limiting where an ambulance can take a mental health patient.

According to the Health Policy Commission, 37.5 percent of people who visited the emergency department for a behavioral health reason boarded more than 12 hours in 2024, down from a high of 39.6 percent in 2022. (Fewer than 10 percent of patients with a physical health problem boarded.) That translates to 4,500 fewer behavioral health patients who boarded in 2024 compared to 2022. Thirteen percent of adults and 11 percent of children who needed inpatient psychiatric care waited more than 48 hours to get that care in 2024, compared to 21 percent of adults and 22 percent of children two years earlier.

A major reason for the improvement is the state started implementing its road map in 2023. MassHealth began reimbursing hospitals for evaluating and treating behavioral health patients in the emergency department, so hospitals could hire additional clinicians to quickly stabilize patients and potentially release them. The state created a diversion program where crisis-intervention teams connect patients who are in the emergency department or at risk of going there to community-based support.

The state contracted with newly created community behavioral health centers, which are essentially urgent care centers with 24/7 crisis support. New mobile teams can visit someone’s house. Police officers have begun transporting people to centers instead of hospitals. Recently, the centers have begun admitting people directly to inpatient psychiatric hospitals, rather than requiring emergency department evaluation.

There are still needs to improve awareness of community-based centers, ensure sufficient services statewide, and simplify hospital admissions. But Meri Viano, associate director of the Parent Professional Advocacy League, a network of families supporting children’s mental health, told the editorial board that simply having 24/7 support is vital. “When a crisis happens, you need intervention within the hour,” Viano said. “We don’t ask someone having a heart attack, will you schedule it at 3:00?”

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents psychiatric hospitals, said since January 2023, nearly 300 new psychiatric beds have opened (even after accounting for beds that closed). State officials also created an online system — replacing phone calls and faxes — to help hospital clinicians find open psychiatric beds. A second phase of this project will soon let hospitals use the software to refer patients to community behavioral health centers.

But despite real improvements, the mental health system is still backed up. Matteodo said psychiatric hospitals can have trouble discharging certain patients. “We have numerous geriatric people in [psychiatric] hospitals for a year or longer because we can’t discharge them to an appropriate nursing home that will take them,” Matteodo said. The Health Policy Commission report says emergency departments can struggle to safely discharge homeless patients or those who lack transportation to follow-up care.

Viano said emergency departments often can’t find placements for children with complex needs, such as those who have a medical condition like diabetes or epilepsy, a developmental condition like autism, or a severe mental health condition that causes aggression. That suggests there may need to be higher insurance reimbursements for patients with multiple needs.

Leigh Simons, vice president of policy and regulatory affairs at the Massachusetts Health and Hospital Association, said patients who need long-term residential care through the Department of Mental Health often can’t get beds because programs are full with court-referred patients.

Additionally, issues that seem relatively minor, like transportation, can matter. Today, ambulances are required to take mental health patients to the closest emergency department, even if that hospital doesn’t have psychiatric beds. Another ambulance may be required to transport them to a psychiatric facility — so the person must wait for a psychiatric bed to open up and for transportation. Regulatory changes could let ambulances take patients to the nearest hospital with psychiatric beds or to a community behavioral health center. Some hospitals are experimenting with using specialized SUVs to transport behavioral health patients.

State efforts have improved the boarding crisis — but the new data make clear that the problems still linger and those efforts need to continue.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.